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

This is VAERS ID 903820



Case Details

VAERS ID: 903820 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
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, Laboratory test, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: eye drops, hydroxyzine, Ivermectin, Xarelto, donepezil, finasteride, melatonin, Tamsulosin, atorvastatin, fluxetine
Current Illness: None
Preexisting Conditions: Dementia, anxiety, glaucoma, hyperlipidemia, COPD
Allergies: Morphine
Diagnostic Lab Data: tests performed at hospital
CDC Split Type:

Write-up: Day following vaccine, fever, sob - went to hospital, COVID+


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=903820


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