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

This is VAERS ID 1404054



Case Details

VAERS ID: 1404054 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain lower, Haemorrhage, Limb discomfort, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021640040

Write-up: Severe lower abdominal pain and bleeding; Severe lower abdominal pain and bleeding; Very painful arms and feels very heavy when lifting / the heavy feeling of the arm; Very painful arms and feels very heavy when lifting / the heavy feeling of the arm; This is a spontaneous report from a non-contactable consumer (patient). A 21-year-old female patient received BNT162B2 (COMIRNATY) at the age of 21-years, via an unspecified route of administration, administered in left arm on 01Jun2021 at 19:15 at single dose for COVID-19 immunisation. The patient medical history was not reported. The patient was not pregnant at the time of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient concomitant medications were not reported. On 01Jun2021, the patient experienced severe lower abdominal pain and bleeding, very painful arms and feels very heavy when lifting / the heavy feeling of the arm. It was reported that very painful arms and feels very heavy when lifting / the heavy feeling of the arm has occurred immediately after vaccination / a few hours after vaccination severe lower abdominal pain and bleeding. Outcome of the events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained


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