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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1274139

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Case Details

VAERS ID: 1274139 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Anaemia, Cardiac failure, Cardiac pacemaker insertion, Cardiogenic shock, Cough, Dialysis, Fatigue, Hyperhidrosis, Hypotension, Myocarditis, Oral candidiasis, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol, Trulicity, metformin, losartan, Protonix, Zetia, Tylenol, aspirin
Current Illness: COVID + on 01/05/2021
Preexisting Conditions: HTN, DM, hypercholesterolemia, SVT
Allergies: penicillin, Daypro, Augmentin, codeine, morphine, Reglan, statins, Mobic, pineapple, paper tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1/20/2021 - pt experiencing marked fatigue 01/23/2021 - pt went to ED with fatigue, sweats, cough, and low BP. Admitted with diagnoses of cardiogenic shock, myocarditis, acute renal failure, heart failure, anemia, UTI, oral thrush. Treated with IV fluids, dialysis, temporary pacemaker. 02/06/2021 - discharged to rehab facility 02/17/2021 - discharged home

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