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

This is VAERS ID 1431316



Case Details

VAERS ID: 1431316 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-27
Onset:2021-06-26
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir, albuterol nebs, diclofenac, fluticasone-salmeterol, gabapentin, hydroxyzine, montelukast, trazodone
Current Illness:
Preexisting Conditions: Vitamin D deficiency, seasonal affective disorder, reflux, radiculopathy - lumbosacral region, pes planus, obesity, neck pain, multiple allergies, herniated lumbar intervertebral disc, GERD, dysphagia, depression, COPD, chronic pain, ADD, asthma, arthritis, anxiety, allergic rhinitis, alcohol abuse, sleep difficulties, hypertension, hypertriglyceridemia, oral herpes simplex, benign neoplasm of breast, cervical spinal stenosis.
Allergies: aspirin, naproxen, jalapenos, gluten meal, salicylates, zofran.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt completed vaccination series for the COVID-19 Pfizer, with one dose received 4/6/2021 and the 2nd received 4/27/2021. Pt was seen at ED on 6/26/2021 for mental health related reasons, and tested positive for COVID-19 as part of routine admission screening. Medical notes indicate the patient was asymptomatic for COVID-19.


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