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

This is VAERS ID 1378425



Case Details

VAERS ID: 1378425 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fall, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12, Zrytec, Calcium x 4, Curamed, Super Adrenal Stress Formula by Dr. Wilson, Fish Oil, Adrenal C Formula, Tegretol XR 200mg bds, Singulair, DHEA, Strontium, estrogen/progestin combo, selenium 200mcg,
Current Illness: respiratory problems
Preexisting Conditions: Hashimotos Disease, Leaky Gut, Asthma, Allergies,
Allergies: multiple allergies: - oats, orange, walnut, pecan, peanuts, mushrooms, shellfish, egg yolks, - allergy tested- out of 91 needles she is allergic to 69 things - avalox, Biaxin, clarithromycin, doxycycline, erythromycin, Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt developed chills and shaking the night after getting the vax. She took tylenol and went to bed. When she woke up she had chills and shaking. She got up to take another tylenol but her body collapsed and she fell to the ground stating she had no control over this. She had to lay and wait a little while before she could get herself up. She was weak the next day but feeling some better today.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1378425


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