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

This is VAERS ID 1779304

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Case Details

VAERS ID: 1779304 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-31
Onset:2021-09-30
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cough, Dysstasia, Fall, Limb injury, Urinary tract infection, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: feeling generally weak, slid out of bed while trying to get up and use her walker, landed on the floor, sat there for several hours, not wanting to disturb her family. Did not hit her head, no LOC. Did not feel "hurt", other than a scratch on her left hand, but had a hard time getting up on her own. She was diagnosed with a urinary tract infection as an outpatient and was started on Duricef yesterday. Denies fevers or chills. She has a nonproductive cough, can hear herself wheezing, states this isn''t normal for her. No chest pain, no difficulty breathing.


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