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From the 1/7/2022 release of VAERS data:

This is VAERS ID 627438

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Case Details

VAERS ID: 627438 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
   Days after vaccination:1
Submitted: 2016-03-16
   Days after onset:6
Entered: 2016-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Public
Symptoms: Activities of daily living impaired, Body temperature increased, Dizziness, Fatigue, Headache, Limb discomfort, Malaise, Muscle disorder, Nausea, Oropharyngeal pain, Pain in extremity, Pruritus, Throat tightness, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 25 mg Daily; Tri-sprintec Daily
Current Illness: Mother and patient denies any illness at the time vaccine was given.
Preexisting Conditions: Patient is allergic to Amoxicillin.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received vaccine at 9am on 3/8/16. Patient become lightheaded but did not pass out, she was given 7 Up and left the clinic without any problems. She went to school and complained of a very sore arm but no other complaints. On 3/9/16 AM, patient was not feeling well, she related headache, nausea, tired and heavy muscles. She did go to school. On 3/9/15 at approximately 5 PM, patient still not feeling well had a temp of 99.1 or 99.7 mother could not recall temp for sure. Given Advil 2 tabs and took a nap. Somewhere around 6PM, patient started to itch on hands and legs. Then somewhere between 7PM and 8:30PM she developed hives on her legs and said "start of a sore throat or tight". Mother emailed Dr., he instructed mother to give one Benadryl. Patient rested again and took regular medications at around 11 PM. On 3/10/16 Patient stayed home from school due to nausea, exhausted, and heavy muscles. On 3/11/16 Patient returned to school without any complaints.

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