We followed 106,349 primary care patients for 22,385,309 person-days across 21 calendar months. There were 69 breakthrough COVID-19 hospitalizations: 65/102,613(0.06%) among fully vaccinated, 3/11,047(0.03%) among those previously infected, and 1/7,313(0.01%) among those with both statuses. This data gives primary care providers real-world context regarding breakthrough COVID-19 hospitalization risk.