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

This is VAERS ID 1725515

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Case Details

VAERS ID: 1725515 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:2020-12-19
Onset:2021-09-07
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Illness, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210907; Test Name: tested Positive for covid; Test Result: Positive
CDC Split Type: USPFIZER INC202101182753

Write-up: tested positive for covid yesterday; tested positive for covid yesterday; I am so sick; This is a spontaneous report from a contactable consumer (patient) or other non-health care professional. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number was not reported) via an unspecified route of administration on 19Dec2020 as dose number unknown, single for covid-19 immunization. The patient medical history and concomitant medications were not reported. On 07Sep2021 yesterday, the patient got that booster out and tested positive for covid and on an unspecified date in 2021 reported that patient was so sick and stated that we were no longer protected. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 07Sep2021. Outcome of the events were unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


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