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From the 7/16/2021 release of VAERS data:

This is VAERS ID 928378



Case Details

VAERS ID: 928378 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-01-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspnoea, Hospice care, Myocardial infarction, Respiratory tract congestion, Tachycardia, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: On: Norvasc 5mg daily Losartan 50mg daily Menest 0.3mg daily Vitamin C 500mg twice a day
Current Illness: N/A
Preexisting Conditions: HX of CHF Pneumonia HTN Cardiac Murmur Osteoarthritis
Allergies: Vasotec, Zocor, and Cymbalta
Diagnostic Lab Data: Unknown, will need to follow up with hospital.
CDC Split Type:

Write-up: Congestion Shortness of breath Tachycardia Transferred out 911. Per hospital, patient had a myocardial infarction, is unresponsive, and on hospice services.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=928378


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