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

This is VAERS ID 1333925

Case Details

VAERS ID: 1333925 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Adenovirus test, Atypical pneumonia, COVID-19, Chest X-ray abnormal, Coronavirus test negative, Cough, Diarrhoea, Human metapneumovirus test, Hypokalaemia, Hypoxia, Influenza A virus test negative, Influenza B virus test, Lung infiltration, Lung opacity, Pneumonia mycoplasmal, Pneumonia viral, Respiratory syncytial virus test negative, SARS-CoV-2 test positive, Sepsis, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler benzonatate (TESSALON) 100 mg capsule multivitamin 400 mcg tablet predniSONE (DELTASONE) 10 mg tablet
Current Illness:
Preexisting Conditions: Respiratory Persistent dry cough Digestive Diarrhea Obesity Musculoskeletal Hidradenitis suppurativa Pes anserinus bursitis of left knee Primary osteoarthritis of left knee Endocrine/Metabolic Hypokalemia Infectious/Inflammatory COVID-19 virus infection Other Abnormal mammogram Multiple allergies Breast mass, left
Allergies: NKA
Diagnostic Lab Data: 05/07/21 0232 Respiratory virus detection panel Collected: 05/07/21 0123 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Synctial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Pertinent Test Results: XR CHEST 1 VW PORT IMPRESSION: Patchy bilateral opacities consistent with atypical pneumonia. This nonspecific imaging pattern can be seen with Covid-19. Other considerations include but are not limited to other infectious etiologies or noninfectious etiologies. END OF IMPRESSION: INDICATION: cough cp sob.Rule out SARS-CoV-2( related to COVID-19) contact, Droplet isolation. TECHNIQUE: Portable AP view of the chest was obtained. COMPARISON: None available. FINDINGS: The cardiac silhouette is normal in size.
CDC Split Type:

Write-up: Clinical Support, 5/4/2021, Family Medicine - LPN, Close exposure to COVID-19 virus, Dx, Covid-19 Screening Reason for Visit. ED to Hosp-Admission Discharged 5/6/2021 - 5/8/2021 (2 days), Hospital, DO, Last attending, Treatment team COVID-19 virus infection, Principal problem, Medical Problems , Hospital Problems, POA, (Principal) COVID-19 virus infection- Yes, Hypokalemia- Yes, Diarrhea- Yes. Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] COVID-19 virus infection [U07.1] Severe sepsis Hospital Course, Pleasant 55-year-old female admitted to the hospital with signs of severe sepsis with associated acute hypoxic respiratory failure. Was found to be febrile, tachycardia, tachypneic, hypoxic on admission. Chest imaging did reveal patchy infiltrates consistent with viral pneumonia. Was diagnosed with COVID-19. Started on antiviral, corticosteroid, and received antibiotic therapies while in hospital. Improved significantly over the course of 2 days and was able to titrate back to room air. I recommended discharge home, she will continue to isolate until 14 days from initial diagnosis. Recommended the use of albuterol as needed, and she will continue a taper of prednisone. She will follow-up with PCP in 7 to 10 days

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