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

This is VAERS ID 904436

Case Details

VAERS ID: 904436 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New Jersey  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase normal, Aspartate aminotransferase normal, Atrial fibrillation, Blood albumin normal, Blood alkaline phosphatase normal, Blood creatinine normal, Blood culture negative, Blood lactic acid decreased, Blood potassium decreased, Chest X-ray abnormal, Gram stain positive, Haematocrit decreased, Hypotension, International normalised ratio increased, Malaise, Palpitations, Platelet count normal, Procalcitonin increased, Protein total normal, Pyrexia, Respiratory tract congestion, Tachycardia, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), Sepsis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flomax 0.4mg Daily
Current Illness: Enterococcus faecalis UTI diagnosed 11/2520 associated with ureteral stent removal 11/10/20 treated successfully with Augmentin
Preexisting Conditions: Borderline HTN, recurrent renal calculi
Allergies: None
Diagnostic Lab Data: Presentation labs: WBC 21.6 Hct 38.9 Plt 227 K 3.3 Cr 1.26 Lactate 2.6 Protein 6.5 Alb 3.5 AST/ALT/AP normal INR 1.4 PTT 48.1 Procalcitonin 4.7 CXR: Mild congestion Cultures Blod, urins (1day): NGTD
CDC Split Type:

Write-up: The patient was well prior to vaccination (12/17). The day after, he felt mildly unwell and had a low grade fever. The following day, he had a fever of 102. He received 1L of fluid at Urgent Care and had a BP ion the 80s. Shortly thereafter, he felt palpitations and developed AF. He came to the hospital where he was tachycardia to 200 bpm and hypotensive to SBP70s. He received aggressive fluid resuscitation (4L), IV metoprolol and was started on empiric Abx. Within several hours, the HR lowered, BP increased, and AF spontaneously converted to sinus. He had no dysuria. Curtures so far have not shown growth at our hospital. Urinary culture from urgent care has reportedly shows 20k gram positive cocci.

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