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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1012766

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Case Details

VAERS ID: 1012766 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Maryland  
Vaccinated:2020-12-23
Onset:2021-01-11
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SC

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cardiomyopathy, Condition aggravated, Death
SMQs:, Cardiomyopathy (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID Infection on 12/28/2020 , mild asymptomatic infection
Preexisting Conditions: Chronic congestive heart failure, DM II with complications, Cardiomyopathy, Hypertension, Chronic Atrial Fibrillation, Past history of cerebral Vascular accident. She did not have any symptoms of allergies from the vaccine, her recovery from COVID virus was uneventful. Her death appeared to be due to her chronic illnesses not from the COVID infection or the vaccine. She was COVID negative on 1/21/21.
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient did not have any adverse events. She tolerated vaccine, Developed COVID infection 12/28/20 and recovered 01/21/21 She died due to her cardiomyopathy


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