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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1344282

Case Details

VAERS ID: 1344282 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Apixaban, Atorvastatin, Calcium gluconate, Meropenem, Vancomycin, Epogen, Benadryl
Current Illness: Pulmonary HTN, CKD (HD 3x a week), cirrhosis (paracentesis 2 days prior to hospital admission), patient developed fever of 103 & chest tightness while at dialysis,, CHF, pneumonia
Preexisting Conditions: aortic valve replacement 2018, aortic tricuspid regurgitation, pancreatitis, home oxygen use 4L/hr, crack use 2018, CHF, BMI 31.3kg
Allergies: Spironolactone, Zofran, Solumedrol
Diagnostic Lab Data: Patient had anemia of chronic disease/CDK, high serum creatinine (HD)
CDC Split Type:

Write-up: received the vaccine as an inpatient in our hospital on 5/21/21. Patient went into cardiac arrest on 5/22/21 at approximately 9:00am

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