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

This is VAERS ID 1169170



Case Details

VAERS ID: 1169170 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-27
Onset:2021-03-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Blood pressure increased, Breast pain, Chest pain, Decreased appetite, Hypertonic bladder, Liver function test increased, Nausea, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Citalopram, Levothyroxine, multivitamin
Current Illness: None.
Preexisting Conditions: Shingles.
Allergies: Lisinopril
Diagnostic Lab Data: 3/30/2021 AM = ER = Epigastric abdominal pain, Elevated BP, vomiting, nausea, LFT elevation, more...
CDC Split Type:

Write-up: 3/30/21 AM = (Patient''s notes) "Chest/breast PAIN throughout night and (previous) day. Pain continuously in back last two (2) days. Nauseated, weak bladder every hour or so. No appetite. 1st Covid shot 3-27.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1169170

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