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

This is VAERS ID 1275910



Case Details

VAERS ID: 1275910 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-27
Onset:2021-03-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, COVID-19, COVID-19 pneumonia, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban, diltiazem, glipizide, lisinopril, metformin, metoprolol, mycophenolate, pravastatin, tacrolimus
Current Illness:
Preexisting Conditions: Extensive past medical history including type 2 diabetes, renal transplantation on chronic immunosuppression, atrial fibrillation on anticoagulation, hypertension
Allergies: None
Diagnostic Lab Data: COVID-19 positive 3/28/21 in ED.
CDC Split Type:

Write-up: Patient presented to ED on 3/28/21 with the following information: patient reports home daughter was diagnosed with COVID-19 infection a few days ago. For about a week now the patient herself has had severe fatigue, loss of taste, loss of appetite, nausea, vomiting and diarrhea. She denies fevers. She has however had a persistent cough and over the last few days has been short of breath. Tested positive for COVID-19 on 3/27/2021 at outside facility. Last night patient had multiple episodes of diarrhea making her fatigue significantly worse today. Has been drinking a lot of free water. Additionally noted increased cough and shortness of breath. Patient was admitted to the hospital with COVID-19 pneumonia on 3/28/21 and expired on 4/13/21.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1275910

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