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

This is VAERS ID 1742576

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Case Details

VAERS ID: 1742576 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-31
Onset:2021-09-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood test, Chest pain, Magnetic resonance imaging, Muscular weakness, Musculoskeletal disorder, Myelitis transverse, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Unsure when symptoms stopped)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Blood test; Result Unstructured Data: Test Result:unknown results; Test Date: 2021; Test Name: Contrast MRI; Result Unstructured Data: Test Result:unknown results; Test Date: 2021; Test Name: MRI; Result Unstructured Data: Test Result:unknown results; Test Date: 20201231; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test
CDC Split Type: GBPFIZER INC202101217545

Write-up: Back pain; Chest pain; Myelitis transverse; Leg weakness; Loss of leg function; This is a spontaneous report from a contactable consumer. This is a report received from the Regulatory Authority. Regulatory authority report number is GB-MHRA-WEBCOVID-202109152217354620-QQK7O with Safety Report Unique Identifier GB-MHRA-ADR 25948565. A 16-year-old male patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on 31Aug2021 as a single dose for COVID-19 immunisation. Medical history included suspected COVID-19 from 24Dec2020 and it was unsure when the symptoms stopped. It was reported that the patient was normally healthy and active. The patient was not enrolled in a clinical trial. On 31Dec2020, the patient underwent a COVID-19 virus test and the result was positive. Concomitant medications were not reported. On 06Sep2021, the patient experienced back pain, chest pain, myelitis transverse and events were reported as serious for causing hospitalisation, disability and for being medically significant. On an unknown date in 2021, the patient experienced leg weakness and loss of leg function. It was reported that the patient was still in hospital and had occasional chest pain. On an unknown date in Sep2021, the patient underwent MRI (magnetic resonance imaging), blood test and contrast MRI and the results were unknown. The patient had not tested positive for COVID-19 since having the vaccine. The clinical outcome of the events back pain, leg weakness and loss of leg function was unknown while the outcome of events chest pain and myelitis transverse was not resolved at the time of this report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


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