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

This is VAERS ID 1286760



Case Details

VAERS ID: 1286760 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase, Aspartate aminotransferase, Death, Dyspnoea, Full blood count, HIV test, Hepatic failure, Liver function test, Metabolic function test, Pneumonia, Pyrexia, Respiratory distress
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: depression, hypertension, high cholesterol,
Allergies: Penicillan
Diagnostic Lab Data: cbc, ast, alt, cmp, HIV screen, full liver panel, many others.
CDC Split Type:

Write-up: fever, shortness of breath, respiratory distress, pneumonia, liver failure, death.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1286760

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