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

This is VAERS ID 1767768

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Case Details

VAERS ID: 1767768 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Heart rate increased, Pain, Palpitations, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Omega 3, multi vitamin, vitamin d, collagen
Current Illness:
Preexisting Conditions: Osler-Weber-Rendu disease
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, vomiting, headache, fatigue, body aches, racing heart rate, heart palpitations for about 24 hrs. Rest & Tylenol


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