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

This is VAERS ID 1415855



Case Details

VAERS ID: 1415855 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   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: Malaise, Musculoskeletal stiffness, SARS-CoV-2 test
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: COVID-19 virus test; Test Result: Negative; Comments: Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021657403

Write-up: Sickness; Stiffness; This is a spontaneous report from a contactable consumer received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106050922139490-LKBP3. Safety Report Unique Identifier GB-MHRA-ADR 25425331. A 34-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 03Jun2021 (at the age of 34 years) (Batch/Lot number was not reported) as 1ST DOSE, SINGLE for covid-19 immunisation. Medical history included lactation decreased Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Patient is not pregnant, Patient is not currently breastfeeding. The patient''s concomitant medications were not reported. The patient experienced sickness and stiffness on 03Jun2021. The events were assessed a serious (medically significant). Lab data includes COVID-19 virus test: Negative COVID-19 test on 04Jun2021. Patient has not tested positive for COVID-19 since having the vaccine. The outcome of the event sickness was recovered on 04Jun2021 and stiffness was recovered on 05Jul2021. No follow-up attempts are possible, information about the batch number cannot be obtained.


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