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

This is VAERS ID 1744292

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Case Details

VAERS ID: 1744292 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? No
Previous Vaccinations:
Other Medications: Vitamin C Zinc Multi Vitamin Atorvastatin Allopurinol Ramipril Aspirin 81
Current Illness: I had a minor score throat two days prior but it seemed to go away.
Preexisting Conditions: Gout, high cholesterol and high blood pressure.
Allergies: Dilaudid Cipro Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore body and shortness of breath


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