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From the 5/14/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 1088338

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Case Details

VAERS ID: 1088338 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-01-13
Onset:2021-03-05
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: COPD, Chronic Bronchitis, Pulmonary Nodular Angloidosis, Morbid Obesity BMI $g70, Obesity Hypoventilation Syndrome, Chronic Diastolic Heart Failure, Anemia, Osteoarthrosis, Dyslipidemia.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case received vaccines 12/23/2020, and 01/13/2021. Public Health received notification that patient died 3/5/2021. Not really sure if her death is related to vaccine administration but I was instructed to fill out this form.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1088338


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