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

This is VAERS ID 1409115



Case Details

VAERS ID: 1409115 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Blood pressure measurement, Body temperature, Chills, Dizziness, Respiratory rate
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210601; Test Name: blood pressure; Result Unstructured Data: Test Result:215/104 mmHg; Comments: at 14:10; Test Date: 20210601; Test Name: body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Comments: at 14:10; Test Date: 20210601; Test Name: respiratory rate; Result Unstructured Data: Test Result:20; Comments: beats/minute at 14:10
CDC Split Type: JPPFIZER INC2021646819

Write-up: The blood pressure was 215/104 mmHg; chills; light-headed feeling; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21111021. The patient was an 86-year-old female. Body temperature before vaccination was not provided. The family history and medical history were not provided. On 01Jun2021 at 14:05 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number unknown, Expiration date unknown) via an unspecified route of administration as a single dose for COVID-19 immunization. On 01Jun2021 at 14:10 (5 minutes after the vaccination), the patient experienced chills and light-headed feeling. On 02Jun2021 (one day after the vaccination), the outcome of the events was recovered. The course of the event was as follows: On 01Jun2021 at 14:10 (5 minutes after vaccination), the patient experienced chills and light-headed feeling. The blood pressure was 215/104 mmHg, the body temperature was 36.2 degrees Celsius, and the respiratory rate was 20 /minute. On 02Jun2021 (one day after the vaccination), the symptoms disappeared. The reporting physician classified the event as non-serious and assessed that the causality between the event and BNT162b2 as unassessable. There was no other possible cause of the event such as any other diseases. Information on the lot/batch number has been requested.


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