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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1032880

Case Details

VAERS ID: 1032880 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Confusional state, Cough, Death, Dyspnoea, Hypertension, Lung carcinoma cell type unspecified stage IV, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proair , Pulmicort , Neds, Tegertol, Plavix , Flonase, Tofranil, Kepra , Protonix Trental Opdivo, Colace, Sim Vastatin, Vit E,
Current Illness: Hospice Chronic COPD
Preexisting Conditions: Cancer chest pain COPD Cough , HX of Radiation and Chemotherapy Hypercholestemia , HTN, Seizure , Shingles, SOB
Allergies: Phenergan, Codeine
Diagnostic Lab Data: Tested positive for Covid +
CDC Split Type:

Write-up: Received Pfizer 1/22/2021. RNA+ 2/4/2021. S/S SOB, cough, confusion. COVID assoc. resp. failure, stage 4 lung cancer, COPD, HTN, former smoker. patient in hospice and died 2/10/2021.

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