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

This is VAERS ID 1761684

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Case Details

VAERS ID: 1761684 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Wisconsin  
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Respiratory tract congestion, Rhinorrhoea
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? No
Previous Vaccinations:
Other Medications: acetaminophen 1000mg BID prn for pain aspirin 81mg daily atorvastatin 20mg daily cholecalciferol 1000IU daily duloxetine ferrous sulfate 325mg daily gabapentin 600mg TID multivitamin daily naproxen 500mg BID Fish Oil 1000mg BID pantoprazo
Current Illness: None documented
Preexisting Conditions: Gastro-esophageal reflux disease, impaired glucose tolerance, dyssomnia, daytime somnolence, peripheral neuropathy, onychomycosis
Allergies: Brewer''s yeast - throat swelling mold - throat swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Runny nose/Congestion

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