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From the 5/14/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 1003382

Case Details

VAERS ID: 1003382 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Alabama  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Bradycardia, Chest pain, Condition aggravated, Death, Diarrhoea, Full blood count, Hypotension, Metabolic function test, Seizure, Urine analysis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aricept, citalopram,carbamazepine, Atorvastatin, gabapentin, calcium citrate, metoprolol, amlodipine, vitamin D
Current Illness: COVID dx on 1/4/2021
Preexisting Conditions: Dementia, epilepsy, HTN, PVD, osteoporosis,
Allergies: PCN, Sulfa ATB
Diagnostic Lab Data: Did order CBC, carbamazepine level, UA and CMP. Results are pending
CDC Split Type:

Write-up: Began with vomiting and diarrhea. C/O chest pain. Bradycardia. Hypotension. 2 seizures in 45 minutes after not having one in years. We gave fluids. Gave Zofran. Comfort measures. Pt passed at midnight. Was completely fine one day before. Had minimal issues with COVID though did have a pneumonia that was treated w ATB early on and resolved.

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