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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1842912

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Case Details

VAERS ID: 1842912 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-04
Onset:2021-11-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Headache
SMQs:

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mother reported headache as reported by patient approximately 10 minutes after receiving vaccination. Patient alert and talkative. He had not eaten or had any liquids recently. Mother advised to give patient water and planned to retrieve a snack for him from the snack machine. Patient has a history of headaches in similar location and mother reported he tends to be very nervous with vaccines. Patient advised to monitor, may take pain reliever PRN and notify provider of any worsening or new symptoms. Mother in agreement.


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