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

This is VAERS ID 1440799



Case Details

VAERS ID: 1440799 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-23
Onset:2021-06-04
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram head normal, Echocardiogram normal, Hypoaesthesia, Infection, Magnetic resonance imaging head normal, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Type 2 Diabetes, Hypertension, Restless Leg Syndrome, Generalized anxiety disorder
Allergies: Unknown
Diagnostic Lab Data: COVID 19 Positive test - 6/4/2021 CT Scan of the head Negative - 6/4/2021 MRI Negative for acute stroke - 6/4/2021 Echocardiogram unremarkable - 6/4/2021
CDC Split Type:

Write-up: Breakthrough infection, includes hospital admission that appears unrelated to COVID 19. Patient reported to the hospital with right sided numbness of the face. Patient had an MRI that was negative for acute stroke.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440799


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