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

This is VAERS ID 1428466



Case Details

VAERS ID: 1428466 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Electrocardiogram normal, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms: low fever, back and chest pain, mild nausea - started 6/4/21 and get worse over 4 days. Urgent care seeked on 6/8/21, EKG shown normal, no treatment received. Symptoms abruptly disappeared on 6/10/21


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1428466


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