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From the 5/7/2021 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 965910

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Case Details

VAERS ID: 965910 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-01-11
Onset:2021-01-22
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELI284 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: not known
Diagnostic Lab Data: Not known at this time.
CDC Split Type:

Write-up: The employee found dead at her home on 1/21/2021.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=965910


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