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

This is VAERS ID 1415857



Case Details

VAERS ID: 1415857 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
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: Fatigue, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Medical History/Concurrent Conditions: Lactation decreased; Suspected COVID-19 (unsure when symptoms stopped)
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021657420

Write-up: Fever; Painful arm; Fatigue; This is a spontaneous report from a contactable consumer received from the Regulatory Authority Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106050933276410-H3S8Y, Safety Report Unique Identifier GB-MHRA-ADR 25425350. A 30-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiry date were not reported), via an unspecified route of administration on 04Jun2021 (at the age of 30 years old) as 1st dose, single for COVID-19 immunization. Medical history included lactation decreased from an unknown date and unknown if ongoing and suspected COVID-19 (unsure when symptoms stopped) from 26Feb2020 to an unknown date. The patient had not had a COVID-19 test. 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 painful arm, fatigue on 04Jun2021 and fever on 05Jun2021. The reporter assessed all events as serious (medically significant). Patient has not tested positive for COVID-19 since having the vaccine. The outcome of the events was not recovered. No follow-up attempts are possible; information about batch/lot number cannot be obtained. No further information is expected.


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