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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1024592

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Case Details

VAERS ID: 1024592 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-02
Onset:2021-02-11
   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 EN5318 / UNK LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER DF1306 / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebral arteriosclerosis, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Ischaemic central nervous system vascular conditions (narrow), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   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: Allopurinol, Ativan, Vit B12, Colace, Ferrous Sulfate, Gabapen Gabapentin, Lansoprazole, LEvsin, Miralax, Mirtazapine, Morphine Sulfate, Multivitamin with minerals, Omeprazole, Senna, Trazadone, Valproic Acid, Vitamin C
Current Illness: acute pyelonephritis, acute respiratory failure
Preexisting Conditions: Metabolic Encephalopathy, Sepsis, anemia, neuropathy, chronic kidney disease, aspergers syndrome, hydronephrosis with uretral calculous obstruction, uterovaginal prolapse, obstructive and reflux uropathy, protein-calorie malnutrition, anxiety, major depressive disorder, gastro-esophageal reflux disese, diabetes mellitus 2.
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reactions noted. Resident is on hospice for end of life care for terminal diagnosis cerebral atherosclerosis. Experiencing respiratory distress 2/10/2021 r/t to hospice prognosis.


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