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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1035897



Case Details

VAERS ID: 1035897 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-02-02
Onset:2021-02-01
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Coronary artery disease, Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   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: Xarelto (20MG Tablet, 1 (one) Oral daily, Taken starting 09/18/2020) Active. Spironolactone (25MG Tablet, 1 tab Oral daily, Taken starting 01/08/2021) Active. Sertraline HCl (100MG Tablet, 1 tab Oral daily, Taken starting 12/28/2020) Act
Current Illness: Acute chronic diastolic CHF exacerbation one month prior One oxygen for stage IV COPD
Preexisting Conditions: Diastolic CHF, Stage 3 chronic kidney disease, adrenal adenoma, COPD stage IV, Coronary artery disease with stents, diabetes mellitus, chronic atrial fibrillation, chronic hypertension, osteopenia.
Allergies: Jardiance: Caused a yeast injection
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received her vaccine on 2/2/2021 in the morning. She was observed for over 15 minutes and had no history of any anaphylactic reaction of any sort. She felt fine and went home. 2/15/2021 we were notified by her family that she had passed away on 2/7/2021 at home. The cause of death was stated as myocardial infarct secondary to coronary artery disease. We do not think it had to do with the vaccine administration. The patient had many comorbidities.


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