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

This is VAERS ID 1709843

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Case Details

VAERS ID: 1709843 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-09-11
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Aspirin; calcium; Lisinopril; Simvastatin; Sotalol; Sildenafil; Novolin; Tamsulosin; Metformin
Current Illness: none
Preexisting Conditions: type 2 diabetes; hypertension; diabetic retinopathy; crohns; frequent PVC''s; hypercholesterolemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: cold symptoms for about 5 days starting on 9/11/21 (sore throat, sinus congestion, nasal congestion). Note wife also tested positive for COVID same day he did


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