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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1378395

Case Details

VAERS ID: 1378395 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
SMQs:, Infective pneumonia (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, CA, Diovan, Fish oil, Gentamicin-prednisolone, Insulin, Metformin, Multivitamin, Omeprazole, rosuvastatin, valsartan Vit C.
Current Illness: unk
Preexisting Conditions: diabetes, HTN, kidney disease
Allergies: none
Diagnostic Lab Data: COVID19 Detection BDMAX
CDC Split Type:

Write-up: breakthrough COVID 19

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