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

This is VAERS ID 1777037

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Case Details

VAERS ID: 1777037 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-10-01
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Muscular weakness, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN,
Allergies: Hydrocodone
Diagnostic Lab Data: Positive COVID test on admission, asymptomatic.
CDC Split Type:

Write-up: Hospitalized for 6 days with generalized bilateral extremity weakness. Asymptomatic for COVID


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