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

This is VAERS ID 1772130

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Case Details

VAERS ID: 1772130 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-27
Onset:2021-09-14
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Headache, Myalgia, Nasal congestion, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: to ER c/o sore throat, headache and nasal congestion x3 days. myalgias, cough


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