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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1405125



Case Details

VAERS ID: 1405125 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA8016 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Chills, Cold sweat, Diarrhoea, Nausea, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEPFIZER INC2021641430

Write-up: fainting due to pain; pain; severe stomach pain and diarrhea; severe stomach pain and diarrhea; cold sweat; nausea; chills; asthenic; This is a spontaneous report from a contactable consumer reporting about herself. A 60-year-old non-pregnant female patient received BNT162B2 (COMIRNATY), 2nd dose via an unspecified route of administration, administered in Arm Left on 01Jun2021 15:45 (Lot Number: FA8016, expiration date not provided) as a single dose for covid-19 immunisation (age at vaccination 60 years). Historical vaccines included 1st dose of BNT162B2 via an unspecified route at age of 60 years old (batch/lot number EW4815) in left arm for Covid-19 immunisation on 21Apr2021 but no other vaccinations within 4 weeks. She had no medical history and no known allergy. Patient was not pregnant at time of vaccination. There were no concomitant medications. Patient had not been diagnosed with COVID-19 prior to vaccination and had not been tested since the vaccination. The patient experienced fainting due to pain, severe stomach pain and diarrhea, cold sweat, nausea, chills, asthenic, all on 01Jun2021 22:45. After approximately 7 hours the patient got severe stomach pain and diarrhoea, cold sweat and nausea. Fainted due to pain. Wokes up and had chills for 30 minutes. Took a shower and went to bed. Woke up the day after (02Jun2021) and was mainly asthenic. No treatment received for all events. The outcome of the asthenic was not recovered, the other events was recovered on 02Jun2021. Follow-up (11Jun2021): Follow-up attempts completed. No further information expected.


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