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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1719213

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Case Details

VAERS ID: 1719213 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-02
Onset:2021-08-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Antineutrophil cytoplasmic antibody negative, Antinuclear antibody, Blood creatinine, Blood culture, Blood glucose, Blood potassium, Blood sodium, Bronchoscopy abnormal, C-reactive protein, Chest discomfort, Computerised tomogram thorax, Cough, Endotracheal intubation, Fatigue, Full blood count, Gram stain, Haemoptysis, Mycobacterium tuberculosis complex test negative, Platelet count, Potassium hydroxide preparation, Procalcitonin, Productive cough, Prothrombin time, Pulmonary thrombosis, Pyrexia, Red blood cell sedimentation rate, SARS-CoV-2 test, Urine analysis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 24th August: CEFTRIAXONA MK 1 GM, PULMICORT 0.5 MG (NEBULIZAR), ALBUGENOL SO/RESP 10 ML. TROPIUM SOLUC P/RESP 10 ML. 26th August: CEFTRIAXONA MK 1 GM, AZTHOMAC 500 MG, PULMICORT 0.5 MG (NEBULIZAR), 27th August: DICYNONE AMPOLLA, PARACONY
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 24th august torax RX, COVID, PCR, c-reactive protein, blood glucose, blood creatinine, 25th august TAC TORAX 29th august torax RX 24th August: sodium, potassium, Baar Direct, 25th August: baar Direct, 26th August: Baar Direct, Latex R.A, c-reactive protein, general urine, ANA, KOH (fungus) 27th August: MTB RIF (tuberculosis), KOH (fungus), GRAM, BAAR direct, 29th August: hemogram blood, c-reactive protein, 31th August: hemogram blood, c-reactive protein, 6th Sept: ANCA 11th Sept: RxTorax AP o PA. 14th Sept: ANCA (negatives)
CDC Split Type:

Write-up: 06-August - 15 August: low fever, fatigue and chest pressure 16 August - 21 August: dry cough and finally with phlegm on 21th August. 22th August - : coughing up blood (profuse blood sputum) 24th August: Hospitalization (Hospital) Diagnostic: Study for "Tuberculosis or fungus". Test for COVID19 Antigens and PCR : NEGATIVES 27th August: MTB NOT DETECTED on fiberoptic bronchoscopy with this treatment the fevers disappeared, during the fiberoptic bronchoscopy the the pulmonologist locates a clot in the upper posterior lobe on the left lung, but leaves it because it risks filling the entire lung with blood with danger requiring intubation. 28th August: changed the antibiotic


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