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

This is VAERS ID 1487126



Case Details

VAERS ID: 1487126 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-07-08
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Electrocardiogram, Pneumonia, SARS-CoV-2 test positive, X-ray
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Pneumonia due to COVID
Preexisting Conditions: COPD, Chronic DVT- on xerelto, CHF, A fib
Allergies:
Diagnostic Lab Data: x-ray and EKG
CDC Split Type:

Write-up: Patient was hospitalized with pneumonia from 7/11/2021- 7/14/2021 related to COVID infection. COVID test positive 7/12/2021. Patient became symptomatic 7/8/2021. Patient was fully vaccinated at this time.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1487126


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