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

This is VAERS ID 1358813



Case Details

VAERS ID: 1358813 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-27
Onset:2021-05-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin atorvastatin
Current Illness:
Preexisting Conditions: Diabetes , congestive heart failure
Allergies:
Diagnostic Lab Data: Unknown if related to vaccine
CDC Split Type:

Write-up: Kidney failure/ death


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1358813

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