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

This is VAERS ID 1428052



Case Details

VAERS ID: 1428052 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-20
Onset:2021-02-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Dyspnoea, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chronic steroid use
Current Illness: UNK
Preexisting Conditions: diabetes mellitus, chronic heart disease, chronic kidney disease, DVT, GERD, HTN, AFIB
Allergies: UNK
Diagnostic Lab Data: positive COVID-19 lab PCR 2/8/2021
CDC Split Type:

Write-up: cough, difficulty breathing, productive cough, 02 requirement, weakness resulting in hospitalization and death. received treatment : Azithromycin and Decadron 02/09/2021-02/19/2020


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1428052

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