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From the 4/30/2021 release of VAERS data:

This is VAERS ID 983189

Case Details

VAERS ID: 983189 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Kentucky  
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, Oxygen saturation decreased, SARS-CoV-2 test positive, Unresponsive to stimuli, Vital functions abnormal
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-19
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam, Amlodipine, Lexapro, Cozaar, Metoprolol, Tylenol
Current Illness: COVID-19
Preexisting Conditions: ASHD, Hyperlipidemia, Hypertension, Dementia, Anxiety, Dysphagia
Allergies: Fosomax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19 by rapid test on 1/6/21. She began to demonstrate a dry cough on 1/11/21. On 1/12/21 at 1723 her oxygen saturation dropped to 79% and oxygen was applied at 4L per nasal cannula. On 1/19/21 at 2130 Patient was unresponsive and without vital signs. Orders were for DNR and CPR was not initiated.

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