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From the 4/8/2021 release of VAERS data:

This is VAERS ID 1048399



Case Details

VAERS ID: 1048399 (history)  
Form: Version 2.0  
Age: 102.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-01
Onset:2021-02-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Diet refusal
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec 10 mg/daily,Synthroid .110, daily multivitamin
Current Illness: Covid-19 (Pos. antibody 12/20/2020), Dementia
Preexisting Conditions: Hiatal Hernia, Dementia
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stopped eating and drinking and died


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1048399


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