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

This is VAERS ID 1437252



Case Details

VAERS ID: 1437252 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-29
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Condition aggravated, Dyspnoea, Oedema peripheral, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) 2.5 MG TABS tablet atorvastatin (LIPITOR) 20 MG tablet Blood Glucose Monitoring Suppl (BLOOD GLUCOSE MONITORING KIT GENERIC) kit calcium (OSCAL) 500 MG tablet clopidogrel (PLAVIX) 75 MG tablet Continuous Blood Gluc Sensor
Current Illness: Hospitalized due to complications of COVID-19 infection from 4/6/2021-4/17/2021 with subsequent admission to subacute rehab facility from 4/17/2021-5/3/2021.
Preexisting Conditions: Type 2 diabetes mellitus with stage 3 chronic kidney disease, with long-term current use of insulin (HCC) Hearing loss Psoriasis Mixed hyperlipidemia CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min DJD (degenerative joint disease), ankle and foot B/L Secondary hyperparathyroidism of renal origin (HCC) HTN, goal below 130/80 Normocytic anemia related to CKD Diabetic neuropathy (HCC) S/P aortic valve replacement CAD (coronary artery disease) Body mass index 28.0-28.9, adult Continuous leakage of urine Mild persistent asthma without complication Benign prostatic hyperplasia with urinary frequency Thin blood (HCC) PAD (peripheral artery disease) (HCC) Pacemaker Polypharmacy COVID-19 Cellulitis of leg, right Cellulitis of leg, left Encephalopathy acute Bilateral lower extremity edema
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive 4/9/2021 and 6/29/2021.
CDC Split Type:

Write-up: Patient presented to emergency department with complaints of worsened shortness of breath and lower extremity edema on 6/22/2021. He was admitted for further management of CHF exacerbation. During screening for placement to post acute rehab facility, patient was found to be COVID-19 positive on 6/29/2021. He was treated for COVID-19 infection in April of 2021. He is still admitted at time of writing.


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