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From the 5/7/2021 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 29271

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Case Details

VAERS ID: 29271 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Unknown
Symptoms: Cough, Cyanosis, Dyspnoea, Hypoxia, Leukocytosis, Pyrexia, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: 11DEC90- WBC 16,700 w/no diff + PHS; ABG(RA)-7.48/PO2 36/PCO2 32; LFTS- NL
CDC Split Type:

Write-up: Pt developed progressive cough, DOE & low grade fever about 24 hrs p/vax x 2wks; Admitted to Hosp from 11DEC to about 20DEC w/bilateral pulmonary infiltrates hypoxemia & mild leukocytosis; No bacteriologic diagnosis was made;

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