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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1398503



Case Details

VAERS ID: 1398503 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-01
Onset:2021-06-03
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pneumonia
SMQs:, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Pneumonia (7 months after receiving Moderna vaccine)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Diagnosed with Pneumonia after receiving both the doses of Moderna vaccine 3 months ago; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (Diagnosed with Pneumonia after receiving both the doses of Moderna vaccine 3 months ago) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Pneumonia (7 months after receiving Moderna vaccine). In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 03-Jun-2021, the patient experienced PNEUMONIA (Diagnosed with Pneumonia after receiving both the doses of Moderna vaccine 3 months ago) (seriousness criterion medically significant). At the time of the report, PNEUMONIA (Diagnosed with Pneumonia after receiving both the doses of Moderna vaccine 3 months ago) outcome was unknown. No concomitant products were reported. No treatment information was provided. Very limited information regarding the events has been provided at this time. Case without patient identifiers and contact information.; Sender''s Comments: Very limited information regarding the events has been provided at this time. Case without patient identifiers and contact information.


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