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

This is VAERS ID 1431093



Case Details

VAERS ID: 1431093 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-04
Onset:2021-06-21
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, SARS-CoV-2 test positive
SMQs:, Cardiomyopathy (broad), Infective pneumonia (narrow), 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? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hypertension
Allergies: unknown
Diagnostic Lab Data: abnormal chest x-ray (unknown date)
CDC Split Type:

Write-up: Individual tested positive for COVID-19 on 06/23/2021 and was sent to hospital. Chest x-rays were abnormal and she was diagnosed with COVID pneumonia in both lungs. Was discharged on 06/27/2021 and is currently on 3L of O2


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1431093


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