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From the 11/19/2021 release of VAERS data:

This is VAERS ID 964617

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Case Details

VAERS ID: 964617 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-01-08
Onset:2021-01-21
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   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: Oxycodone, ventolin, quetiapine, pantoprazole, metoprolol, lorazepam, haloperidol, senna, levetiracetam
Current Illness: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Preexisting Conditions: Alzheimers, Covid, COPD, Mood disorder, convulsions, HTN, anxiety, DM, parkinson''s,
Allergies: Codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death, which I believe is unrelated to vaccination


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=964617


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