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

This is VAERS ID 1758827

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Case Details

VAERS ID: 1758827 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-16
Onset:2021-10-02
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Decreased appetite, Fatigue, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD , CAD, CKD, HTN, PUD, BPH
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: increasing cough , fatigue, increased wheezing, loss of appetite for 5 days


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