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From the 6/11/2021 release of VAERS data:

This is VAERS ID 904386



Case Details

VAERS ID: 904386 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-19
Onset:2020-12-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Palpitations, Sinus tachycardia, Supraventricular tachycardia
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler fluticasone NASAL (FLONASE) 50 MCG/ACT nasal spray escitalopram (LEXAPRO) 20 MG tablet
Current Illness: potassium 3.4 on day of vaccination
Preexisting Conditions: Hypertension, psoriasis
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had vaccine at 1330 on 12/20. At around 1815 she began experiencing heart palpitations. She presented to the ED and she was found to have a heart rate in the 130s. EKG showed junctional tachycardia. She was given 6mg of adenosine and an EKG was repeated and showed sinus tachycardia. Eventually her heart rate decreased to the 70s-90s. She was noted to have a potassium of 3.4 which was repleted. She was admitted overnight for observation. In the morning her potassium was normal and she remained in sinus rhythm. She was discharged later that afternoon.


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