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

This is VAERS ID 1274409

Case Details

VAERS ID: 1274409 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Anal incontinence, Asthenia, Back pain, Blood test, Computerised tomogram, Nausea, Sleep disorder
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: Back pain
Allergies: Avacados
Diagnostic Lab Data: 2 sets of blood work see above answer. 2 ct scan with and without contrast. No results given.
CDC Split Type:

Write-up: Sunday April 11 at about 11pm I started feeling extremely drained of energy and was experiencing some mild abdominal pain. I went to bed shortly after. Was woken at approximately 5am with severe abdominal pain, and extreme back pain in my left kidney. Kidney area was worse than abdominal pain but both were severe. I have had kidney stones in the past, the pain of this was way worse. Was unable to take a bowel movement. Suffered thru with pain increasing until unspecified date at around 2 am I drove myself to unspecified hospital. Was admitted to emergency room and given an in mild pain meds and anti nausea meds. Was given a ct scan of kidney, then a second ct scan with contrast, as well as blood test. After awhile they came back to re draw blood because they said my blood had clotted and they were unable to use it. I was released after 5 hours with no prescriptions or knowing what or why I was in so much pain. Pain lasted until unspecified date

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