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

This is VAERS ID 1376629



Case Details

VAERS ID: 1376629 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Pain
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy pill (Allertec) D3 Supplement Magnesium Citrate Pepcid Complete
Current Illness: None
Preexisting Conditions:
Allergies: Sulfa Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left-side/back pain, sometimes throbbing, sometimes sharp. Felt similar to a mild kidney stone. Passed in a day or so. Note that I felt a slightly more intense version of this a few days after my first dose. I just assumed I had had a kidney stone at that point.


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