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From the 4/8/2021 release of VAERS data:

This is VAERS ID 59281

Case Details

VAERS ID: 59281 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
   Days after vaccination:0
Submitted: 1993-11-15
   Days after onset:18
Entered: 1994-01-26
   Days after submission:72
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Arrhythmia, Cardiac arrest, Cerebrovascular accident, Dyspnoea, Hypokalaemia, Hypoxia, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: diabetes, hypokalema, COPD, old CVA
Preexisting Conditions: diabetes, hypokalemia, COPD, old CVA;
Diagnostic Lab Data: COD cardiorespiratory arrest secondary dx CVA, arrythmia; K-3.3; Creat 0.5; WBC 9.6; HCT 39.0; PO2 48.8; PC02 46.0;
CDC Split Type: AL9353

Write-up: pt recvd vax & pt did not feel well; denies chest pain; phone call from family @ 345; pt having trouble breathing; instructed to call 911 or transport to ER arrived ER 444PM; PO2 48.8, Co2 46.0; K 3.3; creact 5; resp sx cont to worsen;

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