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

This is VAERS ID 1047455



Case Details

VAERS ID: 1047455 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-19
Onset:2021-02-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   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: Amlodipine 10 mg qday, Iron Sulfate 325 mg bid, Lisinopril 20 mg bid, Metoprolol Tartrate 25 mg bid, Milk of Magnesia prn, Tylenol 650 mg prn, Senna Plus prn, Vitamin B 12 1000 mg qday, Vitamin D 50, 000 units qweek
Current Illness: Multiple falls, HTN, TIA, mild cognitive impairment, Gait abnormality, hearing loss, major depressive disorder, osteoporosis, central pontine myelinolysis
Preexisting Conditions: HTN, TIA, mild cognitive impairment, Gait abnormality, hearing loss, major depressive disorder, osteoporosis, central pontine myelinolysis
Allergies: NKDA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Resident deceased


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1047455

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