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

This is VAERS ID 1765683

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Case Details

VAERS ID: 1765683 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (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: Hydrochlorothiazide-25 mg Pantoprazole Calcium with vitamin D3-600 mg
Current Illness: none
Preexisting Conditions: high blood pressure, GERD
Allergies: Sulfa drugs, amoxicillin, erythromycin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Slight rash and itching at and below injection site; injection site pain, redness and slight swelling; tiredness; headache; muscle and joint pain in injection arm; slight nausea; feeling unwell Symptoms began about 6-7 hours after injection, progressively became worse over the first 24-48 hours , but were mostly gone by 60 hours after the injection.


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