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

This is VAERS ID 1711824

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Case Details

VAERS ID: 1711824 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-04
Onset:2021-09-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Headache, Lymphadenopathy, Nausea, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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: BENADRYL; IBUPROFEN; ZYRTEC [CETIRIZINE HYDROCHLORIDE]; VITAMIN D [COLECALCIFEROL]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Fibromyalgia; Postural orthostatic tachycardia syndrome
Allergies:
Diagnostic Lab Data: Test Date: 202109; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Unknown results
CDC Split Type: USPFIZER INC202101167626

Write-up: Severe headache; fever; body aches; severe anxiety; nausea; dizziness; swollen glands; This is a spontaneous report received from a contactable consumer(patient). A 38-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number was unknown and expiry date was not reported) via an unspecified route of administration, on 04Sep2021 13:00, at the Left arm, at the age of 38-year-old, at dose 2, single for covid-19 immunisation in a pharmacy or drug store. The patient''s medical history includes fibromyalgia, postural orthostatic tachycardia syndrome, and anxiety. Concomitant medications in two weeks include diphenhydramine hydrochloride (BENADRYL), ibuprofen, cetirizine hydrochloride (ZYRTEC), colecalciferol (VITAMIN D), and multivitamin (unspecified). The patient previously took cymbalta, phenergan and oxycodone hydrochloride, paracetamol (PERCOCET) and experienced allergies. The patient did not receive other vaccines in two weeks. The patient is not pregnant at the time of vaccination. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number and expiry date were not reported) via an unspecified route of administration, on 14Aug2021 12:30 at the right arm, at dose 1, single, for covid-19 immunisation. The patient did not have prior COVID vaccination. On 07Sep2021, the patient experienced severe headache, fever, body aches, severe anxiety, nausea, dizziness, swollen gland resulted in Emergency room/department or urgent care. The patient underwent nasal swab post vaccination in Sep2021 but the result was unknown. The patient received treatment in response to the events which included fluids, anti-nausea medication, pain reliever. The outcome of the events was not recovered. The lot number for BNT162B2, was not provided and will be requested during follow up.


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