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

This is VAERS ID 992599



Case Details

VAERS ID: 992599 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-31
Onset:2021-01-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lactobacillus Capsule MULTIVITAMINS TABLET CRANBERRY TABLET
Current Illness: COVID-19 POSITIVE 12/14/20
Preexisting Conditions: COPD, DM TYPE 2, CHF, GERD, HYPERTENSION, HYPERLIPIDEMIA
Allergies: Ciprofloxacin, Codeine, Bactrim, Lactose Intolerant
Diagnostic Lab Data:
CDC Split Type:

Write-up: right arm redness


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