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

This is VAERS ID 1775212

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Case Details

VAERS ID: 1775212 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERFF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Injection site pain, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: IC Famotidine, Digest Gold, Quercetin, super Acerola Plus-500 my vitamin C, D3-1000 mg, Acetaminophen-500mg twice a day
Current Illness: Sinus dilation procedure Oct 5,2021 11:15 am
Preexisting Conditions: Sinus issues, digestion
Allergies:
Diagnostic Lab Data: none to date and time
CDC Split Type:

Write-up: injection pain site sore, tiredness, headache, chills, nausea, feeling unwell, decreased appetite


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