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

This is VAERS ID 1417497

Case Details

VAERS ID: 1417497 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body temperature, Chest pain, Chills, Cough, Decreased appetite, Eye pain, Headache, Pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NITROFURANTOIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Kidney stone
Diagnostic Lab Data: Test Date: 20210603; Test Name: fever; Result Unstructured Data: Test Result:37 to 39 Centigrade; Comments: at 20:00
CDC Split Type: BRPFIZER INC2021663416

Write-up: Fever between 37 to 39 degrees; headache; pain in eyes; body pain; chills; body strengthless; no appetite; pain in arm; cough; chest pain; This is a spontaneous report from a contactable consumer (patient). A 46-year-old female patient received first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration, administered in right arm on 02Jun2021 09:00 (at the age of 46-year-old) as single dose for covid-19 immunisation. Medical history included kidney stone. Concomitant medications included influenza A(H1N1) pdm09 vaccine taken for H1N1 influenza immunisation on 15May2021 and nitrofurantoin. On 03Jun2021 at 20:00, the patient experienced fever between 37 to 39 degrees, headache, pain in eyes, body pain, chills, body strengthless, no appetite, pain in arm, cough, chest pain. Seriousness Criteria for events was disability or permanent damage. No treatment was received for the adverse events. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient was not pregnant. The outcome of the events was not recovered. Information on the lot/batch number has been requested.

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