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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1081033

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Case Details

VAERS ID: 1081033 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Wyoming  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood bicarbonate increased, Brain natriuretic peptide decreased, Brain natriuretic peptide normal, Carbon dioxide increased, Death, Dyspnoea, Oedema, White blood cell count normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   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: Acetaminophen 500 PO Q4hrs PRN, Furosemide 20 mg PO daily, Cranberry fruit extract 500 mg PO daily, Cod liver Oil 1 cap PO daily, Brimonidine 0.025% Eye drops, Artificial Tears, Milk of magnesia, guafenesin DM, Debrox otic, Nystatin Powder
Current Illness: Chronic respiratory failure with hypoxia, and edema.
Preexisting Conditions: Closed head injury without loss of consciousness, contusion, edema, chronic respiratory failure with hypoxia, subclinical hypothyroidism.
Allergies: Levofloxacin, bee pollen, and NSAIDs
Diagnostic Lab Data: On 2/7 patient was admitted to the emergency department. Labs CO2: 43 mmol/L (High) BNP: 24.5 (pg/mL) Normal white count
CDC Split Type:

Write-up: Patient expired 2 days after receiving the vaccination. Patient had other signs of deterioration over the course of the previous month with worsening edema and difficulty breathing. Unlikely to be related according to our assessments, but wanted to err on the side of caution.

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