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

This is VAERS ID 1470410



Case Details

VAERS ID: 1470410 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-05
Onset:2021-07-13
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Respiratory syncytial virus test negative, 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: Mfetformin HCL, Pioglitazone, Aspirin, Lisinopril, Ibuprofen, Simvastatin, Tylenol,
Current Illness: None
Preexisting Conditions: DM type 2, HTN, Diabetic Dyslipidemia, Diabetic retinopathy
Allergies: Codeine
Diagnostic Lab Data: Jul 13, 2021@15:17:53 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE , RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid screening. no complaints


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