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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1017549

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Case Details

VAERS ID: 1017549 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-04
Onset:2021-02-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medications amlodipine atorvastatin budesonide cephalexin ciclopirox desloratadine epinephrine flaxseed oil fluticasone propionate glucosamine HCl hydrocodone-acetaminophen ipratropium bromide Keflex lisinopril-hydrochlorothiazide olopatadi
Current Illness:
Preexisting Conditions: Problem List: abscess of sublingual space abscess of submandibular region chronic ethmoidal sinusitis chronic maxillary sinusitis disorder of salivary gland essential hypertension history of asthma hyperglycemia hyperlipidemia leukocytosis localized enlarged lymph nodes mass of hand seasonal allergic rhinitis
Allergies: Penicillins, Levofloxacin, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dr. received an urgent request to call a local Justice of the peace regarding one of her patients who was found dead in her home today. At this time no foul play is suspected. Dr. said the patient was relatively healthy with no major issues other than some hypertension


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1017549


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