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

This is VAERS ID 1474800



Case Details

VAERS ID: 1474800 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-10
Onset:2021-07-15
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Influenza B virus test, 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: Omeprazole, Sucralfate
Current Illness: none
Preexisting Conditions: Migraine Headache, Major depression
Allergies: No allergies
Diagnostic Lab Data: Jul 15, 2021@10:11:05 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid 19 screening


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