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

This is VAERS ID 1758948

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Case Details

VAERS ID: 1758948 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Feeding disorder, Headache, Injection site erythema, Injection site pruritus, Injection site swelling, Nausea, Pain, Pain in extremity, Pyrexia, Tinnitus
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), 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: HIgh blood pressure medication
Current Illness: None
Preexisting Conditions: High blood pressure, Afib
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Terrible headaches, nausea, dizzyness, left arm-swollen, red, itchy, weakness, can''t eat, ringing in the ear (left ear), weakness and pain in legs, severe body aches all over, fever, chills.

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