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From the 1/14/2022 release of VAERS data:

This is VAERS ID 133789

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Case Details

VAERS ID: 133789 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Florida  
   Days after vaccination:1
Submitted: 2000-02-03
   Days after onset:7
Entered: 2000-02-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: No enxyme or EKG evidence of myocardial infarction.
CDC Split Type: WAES00012633

Write-up: Information has been received from a physician concerning her father, an 82 year old male who on 26-JAN-2000 was vaccinated with VAQTA vaccine inactivated. Concommitant medication included a daily vitamin. On 27-JAN-2000 the patient experienced cardiac arrest. He was ''brought back to life, a code was performed, and he was rushed to the nearest hospital". He remained hospitalized at the time of the report and was stable. Cardiac arrest was considered life-threatening. No further information is available.

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