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

This is VAERS ID 1723087

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Case Details

VAERS ID: 1723087 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-26
Onset:2021-09-12
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6203 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Alzheimer''s dementia
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Symptom onset 9/12 with coughing. Admitted to hospital on 9/15 with worsening symptoms but currently doing much better and discharged planned tomorrow for rehab


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