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

This is VAERS ID 1464003



Case Details

VAERS ID: 1464003 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-11
Onset:2021-07-01
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1253 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, COVID-19, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: na
Current Illness: none known
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: COVID- 19 rapid 7/5 positive COVID-19 PCR 7/6 saliva - positive
CDC Split Type:

Write-up: On July 1 traveling back from another state, developed headache and back ache on 7/3 developed fever 102. + test for COVID-19. Symptoms resolved by Mon 7/5


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1464003


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