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

This is VAERS ID 1487446



Case Details

VAERS ID: 1487446 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-01
Onset:2021-07-08
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/8/2021 POSITIVE COVID TEST
CDC Split Type:

Write-up: PATIENT ADMITTED TO REHAB FROM DR''S OFFICE COMPLETED MODERNA VACCINATIONS THE 1ST OF FEBRUARY PER PATIENT STATEMENT ADMITTED TO ACUTE CARE 7/19/21 WITH INTERMITTENT FEVER, SOB STILL INPATIENT


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1487446


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