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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1230008

Case Details

VAERS ID: 1230008 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Alabama  
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Cardio-respiratory arrest, Chest pain, Death, Fibrin D dimer increased, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: D-Dimer on arrival to the ER was critically elevated. 2130 with our normal range being 0-400. Chest CTA negative for PE. Patient was being transferred to a Medical Center by helicopter. Five minutes after takeoff, the helicopter turned around and came back with patient coding. She had been talking and suddenly stopped. Attempts at resuscitation were not successful. The patient expired on 4/16/21.
CDC Split Type:

Write-up: Patient presented to ER on 4/16/21 complaining of chest pain. Patient stated she had the J&J vaccine a month ago and had been having problems. She was also being seen by a cardiologist.

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