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

This is VAERS ID 1474497



Case Details

VAERS ID: 1474497 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-26
Onset:2021-07-15
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event
SMQs:

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: Atorvastatin calcium 80 mg tab Lisinopril 5 mg tablet Fluticasone prop 0.05 mg/1 actuation spr Sodium chloride 0.65% sol (ocean) 1 spray Venlafaxine hydrochloride 75 mg tablet Aspirin 81 mg tab Plavix 75 mg tab Humalog 100 u/1 ml sus
Current Illness: Age-related physical debility Type 2 diabetes mellitus Muscle weakness (generalized) 2019 -nCov acute respiratory disease (last year)/recovered
Preexisting Conditions: Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side Encounter for palliative care Altered mental status Dysphagia Paroxysmal atrial fibrillation Acute kidney failure, unspecified Abnormal levels of other serum enzymes Acute cystitis without hematuria Chronic respiratory failure Encephalopathy, unspecified Cerebral infarction, unspecified Cardiac arrhythmia, unspecified Non-ST elevation (NSTEMI) myocardial infarction Peripheral vascular disease, unspecified Chronic ischemic heart disease, unspecified Manic episode without psychotic symptoms, unspecified
Allergies: Naproxen, Clarithromycin, Nonsteroidal anti-inflammatory drug, Macrolide, Macrobid, Metformin, Biaxin
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: No Adverse Events noted


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