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From the 9/17/2021 release of VAERS data:

This is VAERS ID 998419



Case Details

VAERS ID: 998419 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-08
Onset:2021-01-16
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Artificial Tears Solution 0.4 % (Hypromellose) Instill 1 drop in both eyes as needed for dry eyes QID Aspirin Tablet 81 MG Give 1 tablet by mouth one time a day Lasix Tablet 40 MG (Furosemide) Give 1 tablet by mouth one time a day for CHF T
Current Illness: See below
Preexisting Conditions: HEART FAILURE, UNSPECIFIED TYPE 2 DIABETES MELLITUS WITH DIABETIC NEUROPATHY, UNSPECIFIED NTA (2 pts) ANXIETY DISORDER, UNSPECIFIED BORDERLINE PERSONALITY DISORDER ESSENTIAL (PRIMARY) HYPERTENSION LEGAL BLINDNESS, AS DEFINED IN USA MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE PERSONAL HISTORY OF COVID-19 DYSPHAGIA, OROPHARYNGEAL PHASE PNEUMONIA, UNSPECIFIED ORGANISM TINEA UNGUIUM ONYCHOGRYPHOSIS UNSPECIFIED OPEN-ANGLE GLAUCOMA, INDETERMINATE STAGE UNSPECIFIED PSYCHOSIS NOT DUE TO A SUBSTANCE OR KNOWN PHYSIOLOGICAL CONDITION CHONDROCOSTAL JUNCTION SYNDROME [TIETZE] DEPENDENCE ON SUPPLEMENTAL OXYGEN UNSPECIFIED SEQUELAE OF UNSPECIFIED CEREBROVASCULAR DISEASE SLP OTHER SYMBOLIC DYSFUNCTIONS EDEMA, UNSPECIFIED HYPERLIPIDEMIA, UNSPECIFIED IRON DEFICIENCY ANEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERSONAL HISTORY OF OTHER VENOUS THROMBOSIS AND EMBOLISM CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED
Allergies: Brimonidine, Metformin, Bactrim, tape
Diagnostic Lab Data: N/A-contact facility for any questions or concerns
CDC Split Type:

Write-up: Resident vaccinated-1/8 Resident deceased-1/16


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=998419


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