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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1385929

Case Details

VAERS ID: 1385929 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Ohio  
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Infection, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic kidney disease, coronary artery disease, type 2 diabetes, hypertension, h/o DVT, h/o atrial flutter
Allergies: 1,4-diaminobenzene (reaction not specified), codeine (hallucinations), sulfa antibiotics (unknown reactiion)
Diagnostic Lab Data: SARS-CoV-2 PCR detected by SARS-CoV-2 PCR on 6/8/21
CDC Split Type:

Write-up: Patient had breakthrough COVID-19 infection requiring hospitalization, presenting with 4 day history of cough and diarrhea.

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