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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1658708

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Case Details

VAERS ID: 1658708 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-08-26
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, Vistaril
Current Illness:
Preexisting Conditions:
Allergies: Ibuprofen
Diagnostic Lab Data: Covid-19 08/26/2021
CDC Split Type:

Write-up: Patient received 2nd Moderna vaccine on 03/15/2021. Tested positive for Covid-19 on 08/26/2021.


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