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

This is VAERS ID 1719062

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Case Details

VAERS ID: 1719062 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: buPROPion (WELLBUTRIN XL) 300 MG 24 hr tablet clonazePAM (KLONOPIN) 1 MG tablet docusate sodium (COLACE) 100 MG capsule fluticasone (FLONASE) 50 MCG/ACT nasal spray ibuprofen (MOTRIN) 800 MG tablet levothyroxine (SYNTHROID) 75 MCG tablet lo
Current Illness:
Preexisting Conditions: Endocrine Acquired hypothyroidism Musculoskeletal and Integument Closed fracture of base of fifth metatarsal bone with routine healing, right Genitourinary Menses painful Dysmenorrhea Uterine leiomyoma Other Heavy menses Hx of tubal ligation S/P endometrial ablation BMI 35.0-35.9,adult Obesity (BMI 30.0-34.9) Tobacco abuse Vitamin D deficiency RhD negative History of robot-assisted laparoscopic hysterectomy
Allergies: NKA
Diagnostic Lab Data: COVID-19 RESULT:Detected
CDC Split Type:

Write-up: HPI patient is a 43-year-old female who presents for evaluation. Patient is having mild upper respiratory tract type symptoms with cough nonproductive she has lost her taste and smell. Patient been going on for last 3 to 4 days. As noted her husband is quite sick with regard to GI complaints associated possibly with COVID-19 as well. Patient denies any other significant problems at this point. GI or GU complaints no other cardiac or pulmonary complaints medications were reviewed with the patient as were her drug allergies

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