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From the 5/7/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 1053879

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Case Details

VAERS ID: 1053879 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-01-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Esophageal Cancer with Radiation and Chemotherapy. Patient chose to stop treatment
Preexisting Conditions: Malignant neoplasm of the breast, Esophageal cancer, CAD,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath - related to chronic comorbidities


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=1053879


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