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

This is VAERS ID 1778783

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Case Details

VAERS ID: 1778783 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fluid retention, Lymph node pain, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (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: Tetanus Shot: Localized swelling in the arm Penicillin Shot: Hospitalized
Other Medications: Losartan 100mg (once daily)
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: Penicillin Codeine Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Small rough bumps on right arm, raised whelps that itched and spread through the body, joint aches in legs and arms, sensitivity in lymph nodes in neck, fluid retention underneath both eyes


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