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

This is VAERS ID 1761493

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Case Details

VAERS ID: 1761493 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-29
Onset:2021-10-04
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, SARS-CoV-2 test positive
SMQs:, 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg Oral Tab amitriptyline (ELAVIL) 10 mg Oral Tab baclofen (LIORESAL) 10 mg Oral Tab bisacodyl (DULCOLAX) 10 mg Rectal Supp suppository bisacodyl (DULCOLAX) 5 mg oral delayed
Current Illness:
Preexisting Conditions: Quadriplegia Neurogenic bladder Seizure disorder Respiratory acidosis Hypothermia Encephalopathy Pressure ulcer Acute respiratory failure with hypercapnia Slow transit constipation Unstable angina Acute midline thoracic back pain
Allergies:
Diagnostic Lab Data: POSITIVE COVID TEST 10/4/21
CDC Split Type:

Write-up: ASYMPTOMATIC


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