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

This is VAERS ID 1779606

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Case Details

VAERS ID: 1779606 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Pain, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: xarelto, metoprolol, meloxicam, glimepiride
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt reports whole body aches since vaccine and as of 10/12/21 feeling of pins and needle, tingling on the tongue. Pt also reports loss of appetite.


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