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

This is VAERS ID 1761799

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Case Details

VAERS ID: 1761799 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Headache, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), 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: albuterol q6hrs calcium-vitamin D cetirizine 10mg daily cholecalciferol 400IU daily fexofenadine 180mg daily fluticasone-salmeterol BID fluticasone nasal daily simvastatin 40mg HS triamcinolone topical daily
Current Illness: None documented
Preexisting Conditions: smoker, rheumatoid arthritis, osteopenia, hypercholesterolemia, insomnia, prediabetes, COPD with exacerbation, environmental allergies, sensorineural hearing loss bilateral.
Allergies: iodine - swelling lisinopril - cough seafood - swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Cough, myalgia, fatigue, headaches, chills, congestion

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