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

This is VAERS ID 903806



Case Details

VAERS ID: 903806 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-17
Onset:2020-12-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lorazepam, Depakote, Trazadone, Coreg, Bumetanide, Senna, Bumetanide
Current Illness: Mild cough
Preexisting Conditions: A fib, Gastro reflux, type 2 diabetes, hypertension, edema, anxiety, heart failure, pacemaker, obesity, OA, anemia
Allergies: Codeine, morphine, propafenone
Diagnostic Lab Data: Tests performed at hospital
CDC Split Type:

Write-up: Resident became short of breath 7 hours after vaccine, went to hospital, was COVID+


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