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

This is VAERS ID 1478313

Case Details

VAERS ID: 1478313 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Michigan  
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Fall, Hip fracture, SARS-CoV-2 test positive
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquid, tylenol, plavix, culturelle, colace, synthroid, ativan, namenda, nystatin, seroquel, senna
Current Illness: N/A
Preexisting Conditions: Hypothyroidism, alzheimers, hypertension, osteoarthritis, history of stroke, GERD
Allergies: Dust
Diagnostic Lab Data: Positive COVID PCR on 07/01/2021.
CDC Split Type:

Write-up: Fully vaccinated patient tested positive for COVID upon admission to hospital. Patient admitted through ED on 07/01/21 after fall resulting in hip fracture. Patient tested for COVID with routine admission testing and tested positive. Patient asymptomatic at time of admission for s/s of COVID.

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