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

This is VAERS ID 1317031



Case Details

VAERS ID: 1317031 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Atelectasis, Chest pain, Dyspnoea, Fatigue, Headache, Hiatus hernia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Unknown
Preexisting Conditions: Asthma Discoid lupus Hurthle cell neoplasm of thyroid Post-surgical hypothyroidism
Allergies: Ampicillin, penicillin
Diagnostic Lab Data: CT Angio Pulmonary w/ contrast 05/12/21 14:32:08 IMPRESSION: 1. No CT evidence of major pulmonary embolus, thoracic aortic dissection, or thoracic aortic aneurysm. 2. Basilar subsegmental atelectasis. 3. Small hiatal hernia.
CDC Split Type:

Write-up: This is a 49 Years old Female with asthma, discoid lupus and post-surgical hypothyroidism with Hurthle cell neoplasm of thyroid presenting with 1 weeks of moderate shortness of breath without cough, which began gradually. Patient states that her symptoms first started after she received the first Moderna COVID-19 vaccine on 4/6/2021 and they lasted approximately 6 days. Patient was doing well until she received the second dose of the vaccine on 5/4/2021. Since then, she has been having shortness of breath, fatigue and headaches. Patient also complains of chest pain that is worse with inspiration, and she denies any abdominal pain, no nausea, no vomiting, no swelling to the legs, and no leg pain. Symptoms are worse with exertion


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