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

This is VAERS ID 1433669



Case Details

VAERS ID: 1433669 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-19
Onset:2021-06-21
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Asymptomatic COVID-19, Pancreatitis, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lamictal, losartan, metoprolol tartrate, multivitamin, prilosec, viagra, B1
Current Illness: None.
Preexisting Conditions: peptic ulcer disease, bipolar disorder, hypertension, tinnitus, migraine, hepatic steatosis, GERD, obesity
Allergies: Penicillins
Diagnostic Lab Data: COVID detected PCR on 06/21/21.
CDC Split Type:

Write-up: Fully vaccinated patient admitted to hospital with diagnosis of COVID per PCR. Patient admitted to the hospital on 06/21/21 for left sided upped abdominal pain. Diagnosed with pancreatitis. During admission testing patient has a detected PCR test for COVID. Patient remained asymptomatic for COVID throughout his stay. Discharged on 06/23/2021.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433669


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