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

This is VAERS ID 1454253



Case Details

VAERS ID: 1454253 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-07-07
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none noted
Current Illness: none noted
Preexisting Conditions: none noted
Allergies: none
Diagnostic Lab Data: SARS-CoV-2 N Gene Swab 07July2021 Virus Detected
CDC Split Type:

Write-up: Pt Contracted COVID-19 on 07Jul2021


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454253


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