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

This is VAERS ID 1460011



Case Details

VAERS ID: 1460011 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-07-03
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, Influenza A virus test, Influenza B virus test, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sensipar, Pepcid, Cellcept, Deltason, Demadex
Current Illness:
Preexisting Conditions: major depression, stage 3a kidney disease, status post kidney transplant, hyperlipidemia, chronic back pain
Allergies: codeine, hydrocodone-acetaminophen, sevelamer, tomato
Diagnostic Lab Data: SARS-CoV-2 and influenza AB antigens, POC positive for SARS on 7/3/21
CDC Split Type:

Write-up: Pt received Moderna vaccines on 3/31/21 and 4/28/21. Pt presented to the ED with complaints of diffused fatigue and fever. On 7/3/21 pt was found to be COVID-19 positive.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1460011


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