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

This is VAERS ID 1415839



Case Details

VAERS ID: 1415839 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Mobility decreased, Pain, SARS-CoV-2 test
SMQs:, Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), COVID-19 (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: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result: No - Negative COVID-19 test.
CDC Split Type: GBPFIZER INC2021657281

Write-up: This is a spontaneous report from a contactable consumer, received via the regulatory authority (report number: GB-MHRA-WEBCOVID-202106050734458730-MCVI; safety report unique identifier: GB-MHRA-ADR 25425076). A patient, of unspecified age and gender, received the first dose of BNT162B2 (Pfizer-BioNTech COVID-19 vaccine, batch/lot# not reported), via an unspecified route of administration, administered in arm, on Jun 4, 2021, single dose, for COVID-19 immunisation. The patient medical history was not reported. Patient has not had symptoms associated with COVID-19. Patient was not enrolled in a clinical trial. The patient''s concomitant medications were not reported. The patient experienced pain and shoulder pain on Jun 4, 2021. Additional information: injection was given too high on the arm, which has resulted in severe shoulder joint pain. Unable to lift arm above head. Mobility severely limited since Jun 4, 2021. Pain relief did not help. The patient underwent lab tests, which included COVID-19 virus test: No - Negative COVID-19 test on an unknown date. Outcome of the events: not recovered. The regulatory authority assessed the events as medically significant. No follow-up attempts are possible. Information about lot/batch number cannot be obtained. No further information is expected.


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