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From the 6/11/2021 release of VAERS data:

This is VAERS ID 903800



Case Details

VAERS ID: 903800 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2020-12-17
Onset:2020-12-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram, Full blood count, Malaise, Metabolic function test, Nausea, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: seafood, barbiturates, caffeine, oxycodone, demerol, morphine, acetaminophen, nalbuphine
Diagnostic Lab Data: cbc, bmp, ekg, Chest xray
CDC Split Type:

Write-up: sob, nausea, malaise, vomit, chest pain, throat tightness


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=903800


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