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

This is VAERS ID 1036731

Case Details

VAERS ID: 1036731 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Hampshire  
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Dyspnoea exertional, Nausea, Oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF, venous stasis ulcers
Preexisting Conditions: HTN, polycythemia vera, anxiety disorder, ataxia, backache unspecified chronicity, hyperlipidemia, seizure d/o, h/o skin cancer, osteoporosis, incontinence, arthralgias, dizziness and giddiness
Allergies: Novacaine, ampicillin, sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: SOB, DOE, oxygen desaturation, nausea. Ems transport to ER for eval

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