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

This is VAERS ID 1124259



Case Details

VAERS ID: 1124259 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-17
Onset:2021-03-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, Eliquis, lisinopril, metoprolol tartrate
Current Illness: No acute illnesses noted
Preexisting Conditions: CHF, pulmonary nodules, HYN, hypothydoism, AFib, mitral valve regurgitation, AAA, anxiety, aortic stenosis...Basal cell carcinoma of the right eyelid, cardiac murmur, biatrial enlargement, LBBB, left ventricular hypertrophy, mitral valve insufficiency, nonsustained ventricular tachycardia, premature ventricular contraction, retinal detachment of right eye
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reactions reported by family


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1124259

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