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

This is VAERS ID 1061303



Case Details

VAERS ID: 1061303 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-01
Onset:2021-02-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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: Atorvastatin
Current Illness:
Preexisting Conditions: Pace maker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Patient was found unresponsive in the morning hours after her shot.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1061303

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