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

This is VAERS ID 1417489



Case Details

VAERS ID: 1417489 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Diverticulitis, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific inflammation (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? 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:
CDC Split Type: BEPFIZER INC2021664518

Write-up: pain at arm during 1 or 2 days after 1st injection; Fever the day after vaccination; Intestinal diverticulitis before second dose; This is a spontaneous report from a contactable consumer (patient). A 78-year-old female patient received bnt162b2 (COMIRNATY), first single dose via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) for covid-19 immunisation. The patient medical history and concomitant drugs were not reported. The patient was scheduled for the second dose of vaccine on 04Jun2021 but on the morning of 03Jun2021, she experienced fever and difficult defecation which was diagnosed by the doctor as intestinal diverticulitis. The patient also experienced pain at arm during 1 or 2 days after 1st injection and fever the day after vaccination on unspecified dates. Therapeutic measures (antibiotics) were taken as result of intestinal diverticulitis before second dose (diverticulitis) but the molecules were not specified. Outcome of the event intestinal diverticulitis was unknown, while outcome of the other events was recovered. Information on the lot/batch number has been requested.


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