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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1024343

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Case Details

VAERS ID: 1024343 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-05
Onset:2021-02-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6201 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 8982 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   Days after onset: 0
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: HYDROXYCHLOROQUINE MONTELUKAST METOPROLOL XL PANTOPRAZOLE
Current Illness:
Preexisting Conditions: LUPUS
Allergies: ERYTHROMYCIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT ARRIVED TO ED ON 2/9 IN FULL CARDIAC ARREST


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