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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1678763

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Case Details

VAERS ID: 1678763 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Minnesota  
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Anxiety Generalized Disorder Hypothyroidism Hypertensive Heart With Heart Failure And Chronic Kidney Disease, Hospital: Anxiety Generalized Disorder, Hypothyroidism, Hypertensive Heart With Heart Failure And Chronic Kidney Disease (CKD) Stage 3a Glomerular Filtration Rate (GFR) 45 To 59 (HCC), Chronic Respiratory Failure With Hypercapnia (HCC), Atherosclerosis Aortic (HCC), Rhinitis Chronic, History Of Falling, Chronic Respiratory Failure With Hypoxia (HCC), Acute Lower Respiratory Infection Due To COVID-19, Acute And Chronic Respiratory Failure With Hypoxia (HCC). Non-Hospital: Emphysema (HCC), Nodules Pulmonary Multiple Dyslipidemia, Anemia, Dysphagia Pharyngoesophageal Phase, Loss Hearing Sensorineural Bilateral, Weakness General, Pain Neck, Pain Low Back, Impairment Cognitive Mild, Panic Disorder Episodic Paroxysmal Anxiety, Osteoporosis, Chronic Diastolic (Congestive) Heart Failure (HCC), Psoriasis, Ulcer Gastric Personal History, Diverticulosis, Sleep Related Breathing Disorder Myocardial Infarction Old, Abdominal Pain, Oxygen Dependent, Diverticulosis Colon With Perforation, Other Injury Sigmoid Colon Sequela, Dementia (HCC), Depression Major Recurrent Full Remission (HCC), Fracture Pubis Other Closed Initial Right (HCC), Hypertension Essential Primary
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: 83 y.o female presents to the ED with /co cough. Pt states she was seen by her PCP last week and given a prednisone taper for COPD exacerbation. She states her symptoms have never improved, and in fact, have worsened. She wears 2 L NC at home. She has not been febrile.

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