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

This is VAERS ID 1415903



Case Details

VAERS ID: 1415903 (history)  
Form: Version 2.0  
Age: 30.0  
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 NOT KNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Injected limb mobility decreased, Limb discomfort, Malaise, Pain in extremity, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021657412

Write-up: Painful arm; Arm was so sore and heavy patient could not move it upwards or out rendering her arm useless; patient could not move it upwards or out rendering her arm useless; Fever; headache; felt sick; This is a spontaneous report from a contactable consumer. The regulatory authority report number is GB-MHRA-WEBCOVID-202106051512078700-AHRCN. Safety Report Unique Identifier GB-MHRA-ADR 25425990. A 30-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 03Jun2021 (Batch/Lot Number: Not known) as single dose for COVID-19 vaccination. Medical history included suppressed lactation from an unknown date and unknown if ongoing. Patient has not had symptoms associated with COVID-19. Patient was not enrolled in clinical trial. Patient was not currently breastfeeding. The patient''s concomitant medications were not reported. The patient experienced painful arm on 03Jun2021 with outcome of recovering, fever on 03Jun2021 with outcome of recovered in Jun2021, headache on 03Jun2021 with outcome of recovered in Jun2021, felt sick on 03Jun2021 an unspecified date with outcome of recovered in Jun2021, all reported as disability. Clinical course reported as follow: Arm was so sore and heavy patient could not move it upwards or out rendering her arm useless. Fever, headache and felt sick. Paracetamol did help alleviate symptoms. Symptoms started 12 after jab and lasted about 12 hours. Patient has not tested positive for COVID-19 since having the vaccine. The patient underwent lab tests and procedures which included COVID-19 virus test: No - Negative COVID-19 test on an unspecified date. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


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