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From the 2/18/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 1031909

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Case Details

VAERS ID: 1031909 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood creatinine increased, Blood lactate dehydrogenase increased, Death, Haemoglobin decreased, Platelet count decreased, Red blood cell schistocytes, Reticulocyte count increased, Thrombotic thrombocytopenic purpura
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Haemolytic disorders (narrow), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg PO q4h PRN for pain, amlodipine 10 mg PO daily, atenolol 100 mg PO daily, calcium carbonate/cholecalciferol 600 mg/200 mg PO BID, fluticasone 50 mcg per nare daily, HCTZ 25 mg PO daily, phentermine 37.5 mg PO AC breakfa
Current Illness: None known
Preexisting Conditions: Allergic rhinitis, insomnia, anxiety state, Sjogren''s disease, joint pain, GERD without esophagitis, hypertension, vulvar cysts, recurrent maxillary sinusitis, herpres
Allergies: amoxicillin (swelling), sulfur (swelling), loratadine (rash)
Diagnostic Lab Data: Hgb 5 g/dL Platelets 9k SCr 2 mg/dL LDH 1500 Elevated reticulocyte count
CDC Split Type:

Write-up: Pt received dose #1 of COVID-19 vaccine (Pfizer-BioNTech) on 12/18/20 and dose #2 ( Pfizer-BioNTech) on 1/8/21. On 1/30, patient was evaluated at urgent care due to back pain. No bloodwork done; metronidazole prescribed for 7 days. On 2/8, patient was admitted to outside hospital due to ongoing symptom progression. At time of admission, hgb 5 g/dL and plt 9k. Per Dr. (hematology/oncology), pt with schistocytes, LDH 1500, and elevated reticulocyte count consistent with thrombotic thrombocytopenic purpura (TTP). SCr $g2 mg/dL. Patient immediately treated with plasma exchange and steroids, however continued to decline. Patient expired on 2/14/21.

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