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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1697578

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Case Details

VAERS ID: 1697578 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Washington  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Fatigue, Feeling abnormal, Headache, Musculoskeletal pain, Musculoskeletal stiffness, Neck pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Vit D, Vit C
Current Illness: none
Preexisting Conditions:
Allergies: Sunflower seeds
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The afternoon of the shot I got a sharp pain in shoulder blade on left side - also sharp pain on left side of chest - neck pain - headache. No treatment so far except ibuprofen in the afternoon of the 13th and today, the 14th. Sharp shoulder and chest pain lasted for about 30 mins. Still sore in shoulder blade. Neck pain has been the entire time since it started. Headache has been the entire time with occasional sharp pain in the back of my head. Achy and stiff since the afternoon of the 13th. Completely exhausted. Brain fog today, the 14th.

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