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

This is VAERS ID 1088175



Case Details

VAERS ID: 1088175 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-03
Onset:2021-02-18
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Ascites, Blood potassium increased, Condition aggravated, Death, Intensive care, Paracentesis
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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: 2021-02-18
   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: Unknown
Current Illness: Chronic conditions with acute flare ups, last paracentesis for chronic ascites 1/28/2021.
Preexisting Conditions: NASH Cirrhosis, Diabetes, Multiple paracentesis for chronic ascites, back pain, depression, dyslipidemia
Allergies: Amoxicillin and codeine
Diagnostic Lab Data: ER 2/5 for ascites, paracentesis 2/8/2021 with 9900 mls removed. Outpt labs 2/14 and 2/15 with Potassium levels high 6.3 and 6.1. ER 2/17 with ascites discharged to keep scheduled paracentesis later that week. 2/18 returned due to worsening condition, admitted inpatient on hospice to ICU at 1235 passed away at 1815.
CDC Split Type:

Write-up: death within 30 days of vaccination


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088175

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