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

This is VAERS ID 1484731



Case Details

VAERS ID: 1484731 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-01-28
Onset:2021-07-18
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Influenza A virus test negative, Influenza B virus test, Nasal congestion, Pyrexia, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Montelukast, Albuterol inhalor, candesartan, Omega-3 fish oil, triamcinolone cream, Glyburide/metformin, Atorvastatin, Asprin, Lorantadine,
Current Illness: None
Preexisting Conditions: HTN, DM type 2, Hyperlipidemia, Obesity, Seasonal Allergy, Asthma,
Allergies: Penicillin
Diagnostic Lab Data: Jul 18, 2021@14:23:46 FLU A (CEPHEID) NEGATIVE , FLU B (CEPHEID) NEGATIVE , RSV (CEPHEID) NEGATIVE COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: complaining of headache, congestion, fever and cough x 1 day.


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