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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1125778

Case Details

VAERS ID: 1125778 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Mississippi  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Albumin globulin ratio decreased, Anion gap decreased, Blood albumin decreased, Blood calcium decreased, Blood creatine increased, Blood glucose normal, Blood urea increased, Blood urea nitrogen/creatinine ratio, Carbon dioxide increased, Death, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Hypopnoea, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin decreased, Mean platelet volume decreased, Metabolic function test abnormal, Nausea, Protein total decreased, Pulse abnormal, Pulse absent, Red blood cell count decreased, SARS-CoV-2 test negative, Unresponsive to stimuli, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Isosorbide Dinitrate (20mg TID); Lasix ( 40mg- BID); Omeprazole (20mg- Daily); Clonidine (0.1mg-BID); Trazodone (100mg- Daily)- Metoprolo Tartrate (25mg-BID); Norvasc (10mg- Daily); Coreg (6.25mg-BID); Zoloft (100mg- Daily); Cymbalata (30mg
Current Illness: 2/29/21- Acute Exacerbation of HFrEF, Medication non compliance; uncontrolled hypertension 03/05/2021- Bradycardic Arrest ( Resuscitated- intubated)
Preexisting Conditions: Cardiac Arrest, Anasarca, Uncontrolled Hypertension , Acute Chronic HFrEF; Non ischemic Cardiomyopathy, hyperkalemia, Medication non compliance, Type 2 Diabetes, Dysphagia, Adult Failure to Thrive, Cannabis Abuse, CHF Exacerbation, Major Depression Disorders
Allergies: Codeine, Hydralazine, Sulfa , Acetone Solution
Diagnostic Lab Data: 3/17/21- Covid Nasal Swab- negative 3/19/21 CBC & CMP Abnormal results ( RBC-3.17; HGB-8.3; Hct-26.6; MCH-26.1; MCHC-31.1; MPV-6.8; Glucose-136; BUN-43; Creatine-1.93-BUN/Cre-22.0; Co2-33.9; AGAP-4; Calcium lv-8.2- Total Protein-5.8, Albumin-2.55; A/G Ration-0.8
CDC Split Type:

Write-up: 3/20/21 06:22 pm Resident c/o Nausea and feeling full- Tube feeding placed on Hold- Resident started vomiting- Zofran 4 mg given- Positive outcomes. 03/21/2021- 0430 Resident found unresponsive on morning rounds- w/ weak pulse, shallow breathing. O2 via NC increased to 5 L, NP, Family ( Code Status DNR)- Power of attorney ordered to send out- MR notified- Upon arrival no rhythm detected- Death pronounced at 0445

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