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

This is VAERS ID 1032163

Case Details

VAERS ID: 1032163 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Asthenia, Computerised tomogram abnormal, Death, Disseminated intravascular coagulation, Haemoglobin decreased, Hepatic function abnormal, Metastases to liver, Oedema peripheral, Pain, Petechiae, Platelet count decreased, Purpura, Transfusion, Vaginal haemorrhage, White blood cell count increased
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 2.5 mg via nebulizer q4h PRN for SOB, alectinib 600 mg PO BID, apixaban 5 mg BID, bumetanide 2 mg q other day, calcium-vitamin D 500-200 mg BID, famoitidine 20 mg daily, ferrous sulfate 325 mg BID, methadone 5 mg q6h, midodrine 10
Current Illness: Progressive liver metastases seen on CT 1/26/21 in the setting of metastatic non-small cell lung cancer (diagnosed 9/2020)
Preexisting Conditions: HPV, iron deficiency anemia, abnormal uterine bleeding, history of COVID-19 hospitalization ( 8/2020), migraines, nonalcoholic fatty liver disease, GERD, pre-diabetes
Allergies: iodinated contrast (rash, itching)
Diagnostic Lab Data: On admission (2/6/21): WBC: 37.89k Hgb 5.7 g/dL Plt: 75k On 2/11: WBC 53k Hgb 8.1 Plt: 27k
CDC Split Type:

Write-up: Patient received dose #1 of COVID-19 vaccine on 1/16/21. Within 3 days, she developed petechiae up to ankles, later rising up to her knees. Pt admitted to hospital on 2/6/21 for symptomatic anemia 2/2 vaginal bleeding. Patient received 4 units FFP, 4 units PRBC, 1 unit cryoprecipitate, and vitamin K 5 mg IV. Also started on medroxyprogesterone 20 mg PO TID. Alectinib d/ced due to worsening liver function. Evalauted by OB/GYN and Hematology. Diagnosed with DIC. Patient with worsening bilateral lower extremity edema and purpura with pain and weakness. Palliative care consulted. Patient passed away on 2/11.

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