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From the 5/7/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 1035641

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Case Details

VAERS ID: 1035641 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-24
Onset:2021-02-09
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: Azathioprine 50mg po qd Bupropion XL 300mg po qam Furosemide 40mg po qd Nadolol 20mg po qd Omeprazole 20mg po qd Prednisone 20po qd Spironolactone 25mg po qd
Current Illness: Tobacco Use - 0.5 pack per day cigarette use Autoimmune Hepatitis - flare in 2020, improved with increased immunosuppressants per GI note 12/15/20 Bilateral leg swelling 1/21/21 - Primary care office visit
Preexisting Conditions: Tobacco Use - 0.5 pack per day cigarette use Autoimmune hepatitis Essential Hypertension Migraine Mood disorder Allergic Rhinitis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Healthcare was advised that this patient expired approximately two weeks after receiving her initial COVID vaccination


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