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

This is VAERS ID 1433809



Case Details

VAERS ID: 1433809 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-17
Onset:2021-05-09
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, Nucleic acid test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   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:
Current Illness: 1) COVID 19
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 5/19/2021 Causes of death listed on death certificate: 1) COVID 19


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433809

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