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From the 3/26/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 1120952

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Case Details

VAERS ID: 1120952 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: ATORVASTATIN 10MG 1HS FERROUS SULFATE 325MG 1 QD FLUTICASONE-SALMETEROL250-50 1 PUFF BID FUROSEMIDE 40MG 1 QD GABAPENTIN 300MG 1 TID IPRATROPIUM-ALBUTEROL 0.5-2.5 INHALE TID LIDODERM PATCH APPLY TO BACK QD MAGNESIUM OXIDE 400MG 1 QD METOPRO
Current Illness: SEPSIS SEVERE SEPSIS WITH SEPTIC SHOCK ACUTE KIDNEY FAILURE PNEUMONIA COPD INTERSTITITIAL PULOMANY DISEASE ISCHEMIC INFARCTION OF FOREARM MUSCLE POLYNEUROPATHY OBSTRUCTIVE SLEEP APNEA ANEMIA HYPERLIPIDEMIA NICOTINE DEPENDENCE MAJOR DEPRESSIVE DISORDER RESTLESS LEGS SYNDROME ESSENTIAL PRIMARY HYPERTENSION GERD MUSCLE WEAKNESS DYSPHAGIA OROPHARYNGEAL PHASE DIFFICULTY WALKING LACK OF COORDINATION COGNITIVE COMMUNICATION EFICIT HISTORY OF FALLING DEPENDENCE ON SUPPLEMENTAL OXYGEN
Preexisting Conditions: SEE ABOVE
Allergies: CODEINE, SULFA, REQUIP, TETRACYCLINE, TB TEST
Diagnostic Lab Data:
CDC Split Type:

Write-up: NOTHING LOCALLY AT TIME OF IMMUNIZATION. NO PROBLEM 15-30MINUTES LATER. WAS INFORMED SHE WAS FOUND DEAD THE NEXT MORNING.


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