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

This is VAERS ID 1036655



Case Details

VAERS ID: 1036655 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-13
Onset:2021-01-31
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood creatinine increased, Blood urea increased, Death, Globulins increased, Lymphocyte percentage decreased, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   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: Doxycycline twice daily; gabapentin daily; multivitamin daily; apresoline daily; cyanocobalamin; ascorbic acid; ergocalciferol; eliquis; nitrostat prn; allopurinol; famotidine; isosorbide; labetalol; tylenol; humalog
Current Illness: Chronic Stage IV sacral decubitis ulcer infected with necrotic tissue. Inpatient admit 1/14-1/27 for infected decubitis ulcer, osteomyelitis; bacteremia and possible cirrhosis and underwent multiple debridements while hospitalized.
Preexisting Conditions: ESRD on Dialysis; heart cath; anemia; bells palsy; CHF; Uterine Cancer s/p hysterectomy; CKD; DM; dyslipidemia; HTN; Obesity; AFib.
Allergies: Captopril, lisinopril and plavix
Diagnostic Lab Data: Hospital labs 1/14-1/27 WBC 36.53; BUN 58; Cr 4.48; Albumin 1.5; Globulin 5.7; Alk Phos 667; SGOT 194; SGPT 77; Lymph 0%
CDC Split Type:

Write-up: Death on 1/31/2021 multiple comorbidities


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036655

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