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

This is VAERS ID 1785433

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Case Details

VAERS ID: 1785433 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-09-11
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac operation, Diabetes mellitus, Intensive care, Leukaemia, Myocardial infarction, Pneumonia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, Cardiovascular Disease, Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PUI has a host of illnesses Leukemia Diabetes had open heart surgery three heart attacks Pneumonia and is in ICU. Fully vaccinated.


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