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From the 3/19/2021 release of VAERS data (an older release, current is 6/11/2021):

This is VAERS ID 930341



Case Details

VAERS ID: 930341 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-17
Onset:2021-01-04
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood thyroid stimulating hormone, Chest X-ray, Computerised tomogram thorax, Dyspnoea, Electrocardiogram, Fatigue, Fibrin D dimer, Full blood count, Guillain-Barre syndrome, Metabolic function test, Palpitations, Tachycardia, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole, Klonopin, Wellbutrin, Humira
Current Illness: none
Preexisting Conditions: Ankylosing Spondylitis, Asthma, GERD, peptic ulcer disease, chronic gastritis, anxiety and depression
Allergies: none
Diagnostic Lab Data: 1/7 in ER: CT angiogram, Chest x-ray, CBC, CMP, thyroid panel, D-Dimer.
CDC Split Type:

Write-up: Heart palpitations, tachycardia, PVCs and shortness of breath, fatigue, weakness started on Monday (1/4), worsened over next 2 days. Saw primary doctor on 1/7 who called paramedics to take me to the ER due to EKG results and increased work of breathing. ER doctor suspects mild guillain-barre reaction, I will be following up with cardiology and pulmonology as soon as possible as they were unable to determine exact cause or fix the issues.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210319&IDNUMBER=930341


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