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

This is VAERS ID 1775740

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Case Details

VAERS ID: 1775740 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Washington  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dehydration, Dyslipidaemia, Headache, Hyperglycaemia, Hyponatraemia, Hypovolaemia, Influenza like illness, Liver function test increased, Nausea, Pain, Renal failure, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Lipodystrophy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles
Other Medications: Carvedilol Vitamin D-3 CoQ-10 Colesevelam Ezetimibe Levothyroxine Rosuvastatin Triamterene-hydrochlorothiazide
Current Illness:
Preexisting Conditions: Very healthy. Hypertension and high cholesterol under control for years.
Allergies: Codeine Meloxicam Nitrofurantoin Oxycodone Secobarbital
Diagnostic Lab Data: Diagnosis included ?volume depletion, elevated Lfts, HyponatRemix, dyslipidemia and hyperglycemia.?
CDC Split Type:

Write-up: By 7:00 the night of injection ( 10/1)I had lost my appetite. By 10:00 PM I started getting the chills. Chills off and on throughout the night. The next morning (10/02)I had flu-like symptoms??.achy body, bad headache, chills, no appetite and nausea. Started vomiting. couldn?t even keep water down. All symptoms continued the next day ( 10/03). Knew I was dehydrated so husband took me to the ER. At ER I was diagnosed with extreme dehydration and renal failure. Admitted to the hospital 10/03. In hospital until late 10/05 when discharged.

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