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From the 1/22/2021 release of VAERS data (an older release, current is 9/17/2021):

This is VAERS ID 950893



Case Details

VAERS ID: 950893 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-03
Onset:2021-01-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-07
   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: Ask the nursing home,
Current Illness: Diabetes dementia, cll, trigeminal neuralgia
Preexisting Conditions: Diabetes dementia cll trigeminal neuralgia
Allergies: Shellfish, other
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210122&IDNUMBER=950893


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