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

This is VAERS ID 1490826



Case Details

VAERS ID: 1490826 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-09
Onset:2021-07-18
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Nexium, Metoprolol, Glucosamine, Mobic, Fosamax
Current Illness:
Preexisting Conditions: GERD, HTN, Osteoporosis
Allergies: Augmentin
Diagnostic Lab Data: COVID-19 Rapid Antigen Test
CDC Split Type:

Write-up: Breakthrough COVID19 infection


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