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

This is VAERS ID 1464512

Case Details

VAERS ID: 1464512 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Pennsylvania  
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Exposure to SARS-CoV-2, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 mg tablet ADVAIR HFA 230-21 mcg/actuation inhaler albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler benzonatate (TESSALON) 100
Current Illness:
Preexisting Conditions: Non-Hospital Asthma, moderate persistent Cardiomyopathy (CMS/HCC) Chronic joint pain Generalized osteoarthritis of multiple sites Hypertension Morbid obesity (CMS/HCC) Osteoarthritis Overweight(278.02) Vitamin D deficiency Keratosis Encounter for long-term opiate analgesic use Abscess Glenohumeral arthritis, right Controlled substance agreement signed Adenomatous polyp of colon, unspecified part of colon Benign prostatic hyperplasia with nocturia Rotator cuff arthropathy, right Hyperkalemia Pneumonia due to COVID-19 virus UTI symptoms Herpes zoster without complication
Allergies: FentanylConfusion / Delirium, Headaches Doxycycline OseltamivirRash PregabalinFatigue Tetanus ToxoidOther (document details in comments) Tetanus Toxoid, AdsorbedOther (document details in comments)
Diagnostic Lab Data: 07/06/21 1613 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/06/21 1459 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 07/06/21 1613 COVID-19 PCR - Communal Living / SNF Placement (Asymptomatic) Collected: 07/06/21 1459 | Final result | Specimen: Swab from Nasopharynx
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