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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1024157



Case Details

VAERS ID: 1024157 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-11
Onset:2021-01-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Decreased appetite, Diarrhoea, Oxygen saturation decreased, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   Days after onset: 9
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin, HCTZ, Sertraline, Donepezil, Fenofibrate, Vitamin D3, Vitamin B12, Zyrtec, 81mg Aspirin, Colace
Current Illness: Alzheimer''s, Type II Diabetes
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: 7 days after receiving the vaccine, patient suffered excessive diarrhea and slight coughing. 9 days after vaccine, patient was tested for Covid 19, and received positive results. Patient was transported to hospital via ambulance but hospital returned her to the nursing home since chest was clear, no respiratory issues, and no fever. 10 days after receiving the vaccine, patient was turned over to hospice care but still in the nursing home. Hospice was called in to provide better physician advice and access 24/7. 14 days after receiving vaccine, patient began experiencing excruciating body aches, coughing, low oxygen levels, and no appetite. 18 days after vaccine, patient died.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1024157

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