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From the 11/19/2021 release of VAERS data:

This is VAERS ID 916497

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Case Details

VAERS ID: 916497 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Catheterisation cardiac normal, Chest discomfort, Chills, Coronary artery disease, Echocardiogram abnormal, Ejection fraction decreased, Haematocrit normal, Haemoglobin normal, Hypokinesia, Left ventricular end-diastolic pressure increased, Myalgia, Nausea, Red blood cell sedimentation rate increased, Stress cardiomyopathy, Troponin increased, Ventricular hypokinesia, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D3, omega-3, Vitamin A/C, psyllium
Current Illness: none
Preexisting Conditions: History of Renal Cell Carcinoma s/p nephrectomy, Hyperlipidemia, osteopenia, sinus bradycardia, cervical radiculopathy
Allergies: None
Diagnostic Lab Data: TTE 12/30: EF 35%. Regional variation with normal contraction at the base and hypokinesis of the mid and distal segments with perhaps some sparing of the apex. Pattern is consistent with Takotsubo cardiomyopathy. Cardiac Catheterization 12/30: Mild Coronary Disease in LAD. Otherwise minimal CAD. Mildly elevated left sided filling pressure. ESR: 24 CRP <5 WBC 6.46, H/H 13.7/39.7
CDC Split Type:

Write-up: Patient started having myalgia, chills, nausea on the next day of the vaccination. on 2nd day (12/29) patient had chest pressure which made her present to Hospital ED. She had troponin elevation to 1.14. Cardiac Catheterization was done which was negative. On Trans Thoracic Echocardiogram, patient was found to have hypokinesis of the mid and distal segment with some sparing of apex proving Takotsubo (stress induced) cardiomyopathy. Patient did not have any underlying emotional or physical stress going on in her life or family. Till now extensive infectious as well as inflammatory work up is done to rule out any secondary causes of cardiomyopathy which till date have remained negative. As a diagnosis of exclusion, her presentation seems to be COVID-19 vaccine induced Takotsubo Cardiomyopathy

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