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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1299700



Case Details

VAERS ID: 1299700 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-23
Onset:2021-05-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Pneumonia
SMQs:, Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s wife stated that on Sunday he was feeling weak most the day. She took his blood oxygen because he is on oxygen for COPD and it was lower than normal. She turned his oxygen up to 5%, then took his blood pressure. His blood pressure was 256/136, so she called the ambulance. When he was brought into the hospital they put him on a ventilator. He is still on a ventilator as of 5/8/2021. The hospital staff said he had double pneumonia and they plan on trying to take him off the ventilator on 5/10/2021.


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