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

This is VAERS ID 1776714

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Case Details

VAERS ID: 1776714 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Back pain, COVID-19, Chills, Cough, Decreased appetite, Diarrhoea, Hyperhidrosis, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Covid + on 10/10/2021. Patient received Pfizer with with 1st dose on 02/08/2021 and 2nd dose 03/01/2021. Per ED Note: History of Present Illness Patient is a 76-year-old male who denies any significant past medical history that presents to the emergency department with a chief complaint of generalized weakness and diarrhea. Patient states that he got his Covid and influenza vaccine simultaneously approximately 1 week ago. This was the patient''s third Covid vaccine. The patient states that a couple days afterwards he subsequently began experiencing generalized weakness, decreased appetite, fevers, chills, sweats. Patient states he is also developed a cough and diarrhea. Patient denies any nausea vomiting or abdominal pain. Patient does endorse that he has had back pain. Patient states he tried to alleviate the back pain with Robaxin. Patient states he is generally well and does not take any significant medications except for a statin, baby aspirin, and a vitamin.

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