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

This is VAERS ID 1758910

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Case Details

VAERS ID: 1758910 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-02
Onset:2021-10-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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: Gabapentin
Current Illness:
Preexisting Conditions: On hospice care
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, muscle and body pain


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