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

This is VAERS ID 1759087

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Case Details

VAERS ID: 1759087 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-02
   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 - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: psoriasis, Received an Ilyumana injection 9/30/2021 at 1:35 pm
Preexisting Conditions: Heart attack, arthritis, spinal spondylitis, degenerative disc disease
Allergies: Flexeril, fish oil
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever, chills, fatigue, soreness at injection site


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