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

This is VAERS ID 996591



Case Details

VAERS ID: 996591 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-23
Onset:2021-01-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Death, Hypotension, Hypoxia, Mental status changes
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: citalopram, Wellbutrin, docusate, Seroquel, acetaminophen, senna, may have received hospice medications
Current Illness: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Preexisting Conditions: Dementia, depression, arthritis, IBS, atherosclerosis of aorta, hyperlipidemia, osteoporosis
Allergies: Codeine Penicillin simvastatin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: patient received vaccine on Jan 23, 2021. developed weakness on Jan 25, 2021. Sent to ED on Jan 27, 2021 with hypoxia requiring 6 L O2, low Bp, declining mental status. Per family request transitioned to hospice and passed away on Jan 30, 2021


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=996591


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