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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1695794

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Case Details

VAERS ID: 1695794 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Lymph node pain, Lymphadenopathy, Oropharyngeal pain, Pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, sertraline, bupropion, Probiotic, daily vitamin, zinc/ vitamin c
Current Illness:
Preexisting Conditions: Hypothyroidism, asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, enlarged and sore lymph nodes under jaw on right side, sore throat, body aches, and chills


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