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From the 5/7/2021 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 934745

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Case Details

VAERS ID: 934745 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Iowa  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Heart rate increased, Musculoskeletal stiffness, Oxygen saturation decreased, Peripheral coldness, Presyncope, Pulse absent, Respiratory rate increased, Seizure like phenomena, Skin discolouration, Skin warm, Thrombosis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Exelon 13.3 mg daily, APAP 500 mg three times a day, Namenda 10 mg two times a day, Senna 8.6 mg two tablets daily, Mirilax 27 grams two times a day, 2 cal 4oz three times a day, Amlodipine 5 mg daily
Current Illness: NA
Preexisting Conditions: Alzheimers, dementia, hypertension,
Allergies: NKA
Diagnostic Lab Data: Family requested comfort cares. No tests provided.
CDC Split Type:

Write-up: Resident had seizure like activity followed by a vagel response with large bowel movement. Resident then began to show signs of blood clot to left lower extremity. No pedal pulse, area on leg warm to touch. Left lower leg now cold to touch, stiff, purple and white in color. No other signs of modeling, body warm to touch, no fever noted. Respirations and pulse increased with low oxygen levels. Resident not responding to stimuli.

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