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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1240263



Case Details

VAERS ID: 1240263 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-16
Onset:2021-04-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Diarrhoea, Dyspnoea, Ear pain, Feeling jittery, Hypertension, Neck pain, Pain in extremity, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Yellow Fever-severe muscle pain and pain in mid-back, age 60, 2016; Prevnar-13-body aches, fever, diarrhea, age 62
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies: Penicillen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Five days after receiving the Pfizer vaccine, I had a sudden onset of neck & shoulder pain on my left side, radiating up into my left ear & across my chest. My chest was tight. It hurt in my neck and shoulder and chest to take a deep breath. Shortly after, I felt jittery inside & started getting chills. The backs of my legs were quaking against the chair and I got really cold. My blood pressure went up to 149/78. I also had one bout of diarrhea.


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