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

This is VAERS ID 1752961

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Case Details

VAERS ID: 1752961 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray, SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
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:
Current Illness: Alcohol use (Consume 3 times a week); Diabetes; Hypertension; Polycythemia vera ((diagnosed last 2018)); Smoker (not sure how many cigarettes he was consuming)
Preexisting Conditions: Comments: No known allergies or drug abuse or illicit drug usage.
Diagnostic Lab Data: Test Date: 20210922; Test Name: COVID-19 virus test; Result Unstructured Data: positive; Test Date: 20210922; Test Name: Chest X-ray; Result Unstructured Data: No significant cardiopulmonary findings
CDC Split Type: PHJNJFOC20210957174

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a consumer concerned a 54 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: polycythemia vera, hypertension, diabetes, alcohol user, smoker and other pre-existing medical conditions included: no known allergies and drug abuse or illicit drug usage. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 212C21A, and expiry: unknown) dose was not reported, frequency time 1 total was administered on 06-AUG-2021 in right deltoid for prophylactic vaccination. Concomitant medications included acetylcysteine, amoxicillin trihydrate/clavulanate potassium (Co-amoxiclav) for cough, hydroxycarbamide (hydroxyurea) for polycythemia vera, amlodipine besilate/telmisartan (Twynsta), clopidogrel and Galvus met for unknown indication. On 13-SEP-2021, the patient experienced fever after he got back from work, also had cough and colds so he was tested for covid on 22-SEP-2021 and got a positive result (suspected clinical vaccination failure) on 23-SEP-2021 "the result will be given once they are cleared or have finished their quarantine" (sic). The patient had suspected covid-19 infection and chest X-ray (NR: not provided) showed no significant cardiopulmonary findings. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from suspected covid-19 infection, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This case is associated with PQC number: 90000195116; Sender''s Comments: V0 20210957174-COVID-19 VACCINE AD26.COV2.S-suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.

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