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From the 5/7/2021 release of VAERS data:

This is VAERS ID 857606

Case Details

VAERS ID: 857606 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Life support, Loss of consciousness, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-12-14
   Days after onset: 4
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine 10 mg aspirin 81 mg carvedilol 25 mg cyanocobalamin 2500 mcg fenofibrate 160 mg finasteride 1 mg furosemide 20 mg gabapentin 300 mg glimepiride 4 mg hydralazine 25 mg x3 hydrochlorothiazide 25 mg insulin glargine 300 u/ml janumet
Current Illness:
Preexisting Conditions: Hypertension Neuropathy Carpal Tunnel Diabetes 2 Anesthesia of skin Trigger FInger
Allergies: Sulfa (sulfonamide antibiotics) anaphylaxis Penicillins Anaphylaxis
Diagnostic Lab Data: Her doctors in the hospital were not in communication with her doctors outside of the hospital. She had a stress test done a week prior and quite a few labs within pryor. Most of her labs were normal. Her kidneys were beginning to weaken and she had just gotten a recommendation to see a nephrologist. The doctors in the hospital said that she didn''t have a heart attack. There was no heart damage. Her EF was 65. Earlier that day, when she got the vaccines, her vitals were BP 150/64, Temp 97.6 Pulse 89, Oxygen 96%. Her reason for the visit: healthcare maintenance and alopecia. Her death certificate says acute coronary arrest (days), respiratory failure (days). Again , her hospital doctors weren''t in communication with her regular doctors. The office visit clearly showed no signs of respiratory distress. She was with a friend in a car at the time and her friend said that she was fine right up until she died.
CDC Split Type:

Write-up: On 12/10 around 3pm she had a 2 vaccines. Fluzone High Dose 180 mcg/0.5mL and Varicella-zoster 50 mcg/o.5mL. At 9:20pm, after going out to a movie, she suffered sudden cardiac arrest. 911 was immediately called. She never regained consciousness and was taken off of life support on 12/14. I asked multiple doctors why they thought her heart stopped and none of them knew why. I explained to them that I (her daughter) have a genetic condition called MCAS which has been linked to Kounis Syndrome which can cause coronary vasospasms. I was told it was too rare to consider. A couple of weeks later I found her vaccination papers. I called her doctor''s office to let them know. The woman on the phone pulled up her name. As she was reading, she said that they hadn''t been informed and thanks for letting them know and suddenly her entire tone changed and she said I''d have to talk to someone else and hung up. I believe she was trying to transfer me but I can''t help but wonder if she was having a small reaction earlier that day in the office and they let her go.

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