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

This is VAERS ID 1779280

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Case Details

VAERS ID: 1779280 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-30
   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 - / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis perforated, Blood test, Computerised tomogram abdomen, Pyrexia, SARS-CoV-2 test negative
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nora-be (contraceptive) Iron Probiotic Zinc Vitamin-D Claritin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I had a COVID test (negative) and did blood work on 10/6. I had an abdominal CT scan on 10/7.
CDC Split Type:

Write-up: I started experiencing abdominal pain and fever on 10/1. I was told to take ibuprofen for the fever and Pepcid and Pepto Bismol for the abdominal pain. I was admitted to the hospital for an appendectomy on 10/8. The doctors found my appendix had completely ruptured.


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