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

This is VAERS ID 1328923

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Case Details

VAERS ID: 1328923 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Apathy, Dyspnoea, Investigation, Nausea, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiac failure; Cardiac fibrillation; Gout
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 202102; Test Name: Investigation; Result Unstructured Data: Test Result:search for infection; Comments: in urine, lungs, unclear where it was.
CDC Split Type: SEPFIZER INC2021545053

Write-up: severe nausea the same evening as the vaccination; apathetic; Breathing difficulties; she gurgled as if the lungs were full of water; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB, regulatory authority number SE-MPA-2021-034142. An 86-year-old female patient received first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration in Feb2021 (Batch/Lot Number were not reported) as single dose for COVID-19 immunisation. Medical history included ongoing cardiac fibrillation, ongoing cardiac failure and ongoing gout. The patient''s concomitant medications were not reported. The reporter stated that in Feb2021 the patient experienced severe nausea the same evening as the vaccination. The woman was very ill about 7-8 days after the vaccination. Suddenly apathetic. Hospitalized for a week. At home for a day, sudden severe breathing difficulties. Hospitalized for two weeks, search for infection in urine, lungs, unclear where it was. The patient was sent home. Breathing difficulties for eleven days. The last day she gurgled as if the lungs were full of water. The events were serious life-threatening, caused hospitalization and the outcome was fatal. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: nausea; illness; apathetic; Breathing difficulties; she gurgled as if the lungs were full of water

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