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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1260378

Case Details

VAERS ID: 1260378 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Vermont  
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Ageusia, Headache, Oropharyngeal discomfort, Pain in extremity, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrace
Current Illness: None
Preexisting Conditions: Back pain
Allergies: Amoxicillin
Diagnostic Lab Data: Went to doctors and had me have a covid test,came back negative,and they told me it was a viral infection and gave me a antibiotic for five days but still don''t feel any better.
CDC Split Type:

Write-up: Had severe headache, runny nose , scratchy throat,bad leg pain, stomach pain,and loss of taste on certain things,and still have symptoms to this day,and very tired all the time

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