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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1374530



Case Details

VAERS ID: 1374530 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Rash macular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT CAME IN AND SAID ARM WAS SPLOTCHY WITH BRUISES AND UPPER ARM FELT KNOTTED UP ABOUT A WEEK AFTER GETTING A PFIZER COVID SHOT. PATIENT DOESN''T RECALL HITTING HIS ARM ANYWHERE. UPON QUESTIONING, PT IS ON BLOOD THINNERS. ARM IS NOT RED, RAISED, AND DOES NOT HAVE A RASH.


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