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

This is VAERS ID 1478326

Case Details

VAERS ID: 1478326 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Fall, SARS-CoV-2 test positive
SMQs:, Accidents and injuries (narrow), 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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, cardizem, flonase, lasix, avapro, xopenex, melatonin, lopressor, senna, zanaflex
Current Illness: N/A
Preexisting Conditions: hyperlipidemia, depression, ADHD, CKD stage 3, GERD, osteoarthritis, coronary artery disease, hypertension, afib, obesity, COPD, cardiorenal syndrome, RLS, cervical spinal stenosis
Allergies: ciprofloxacin, bee pollen, PCN, sulfa''s
Diagnostic Lab Data: COVID Positive PCR on 07/01/2021. Prior COVID positive test in April per family.
CDC Split Type:

Write-up: Fully vaccinated patient tested positive for COVID upon admission to hospital for unrelated event. Patient admitted through ED on 07/01/21 for orthopedic needs after a fall. No s/s COVID throughout stay. Patient also with positive COVID test in 04/2021.

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