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

This is VAERS ID 1768633

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Case Details

VAERS ID: 1768633 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-09-14
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data: COVID 19 Antigen Positive 9/14/2021
CDC Split Type:

Write-up: Breakthrough case after Covid vaccination. Dose #1 4/8/2021. C/O fever, runny nose, SOA, cough/ onset 9/14/2021


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