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

This is VAERS ID 1776377

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Case Details

VAERS ID: 1776377 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-09
Onset:2021-10-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Axillary pain, Chest discomfort, Chills, Cough, Fatigue, Feeling cold, Headache, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fiber pills, vitamin c, calcium supplements, vitamin d supplement
Current Illness: None
Preexisting Conditions: Sleep apnea
Allergies: Morphine, bee venom
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I have had a fever since the 10th. My left arm, left arm pit, and left side of my chest is sore. I have a dry cough. My head hurts occasionally. I feel fatigued and get cold chills occasionally. I''ve had stomach issues on and off.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1776377


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