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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1744434

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Case Details

VAERS ID: 1744434 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-04
Onset:2021-09-27
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Chest discomfort, Chest pain, Discomfort, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA, Metoprolol, Losartan, Tylenol, Prilosec, Levothyroxine, Tylenol, Multivitamin, Docusate-senna
Current Illness: Unknown
Preexisting Conditions: HTN, Hypothyroid
Allergies: No known allergies
Diagnostic Lab Data: 09/27/21 SARS COV2 COVID 19 PCR (DETECTED--INCIDENTAL FINDING S/P CARDIAC ARREST)
CDC Split Type:

Write-up: 09/27/21 The patient presents with chest pain and SOB starting around 01:30. After feeling uncomfortable with chest pressure symptomat all night, Pt called EMS and received 324mg ASA and nitro x1 en route. Pt states she is still having chest pressure but currently it is minimal. Pt states she was feeling fine yesterday and denies fever, cough, congestion, back pain, hematuria, and NVD. Pt has not had this feeling before. Pt notes that the pain is mostly on her left side and does not radiate.


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