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

This is VAERS ID 1771442

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Case Details

VAERS ID: 1771442 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Connecticut  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Fatigue, Imaging procedure, Laboratory test, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Norvasc, Vitamin D3, Melatonin, Omeprazole
Current Illness: Constipation, deconditioning
Preexisting Conditions: HTN, Cardiomyopathy, GERD, Osteoporosis, DM,. IBS
Allergies: Sulfa, Codeine, Gluten, Whey, Lactose
Diagnostic Lab Data: Imaging 10/6, Labs 10/7
CDC Split Type:

Write-up: Fatigue, Myalgia, Shortness of Breath, Fever, Diarrhea

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