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

This is VAERS ID 1775484

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Case Details

VAERS ID: 1775484 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-28
Onset:2021-10-10
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia
SMQs:, Infective pneumonia (narrow), 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: none
Current Illness: none
Preexisting Conditions: obesity, hypertension
Allergies: COCONUTS, APRICOTS
Diagnostic Lab Data: NO ADVERSE EVENTS HOWEVER DIAGNOSED WITH COVID-19 PNEUMONIA 10/10/2021
CDC Split Type:

Write-up: NO ADVERSE EVENTS HOWEVER DIAGNOSED WITH COVID-19 PNEUMONIA 10/10/2021


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