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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1505250

Case Details

VAERS ID: 1505250 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Death, Full blood count, Metabolic function test normal, Pulseless electrical activity, SARS-CoV-2 test negative, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiac arrhythmia terms, nonspecific (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: one dose of dramamine given in the evening prior to arrival.
Current Illness: none
Preexisting Conditions: none, remote history of asthma
Allergies: none
Diagnostic Lab Data: CBC, CMP normal except slightly elevated glucose COVID PCR negative
CDC Split Type:

Write-up: patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death.

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