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

This is VAERS ID 1491031



Case Details

VAERS ID: 1491031 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-07-15
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Facial paralysis, Gastrostomy, Hemiparesis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: apap, acidophilus, ativan, plavix, lasix, potassium chloride
Current Illness: Conjunctivitis
Preexisting Conditions: Dementia, CHF/HTN, Osteoporosis,
Allergies: no known drug allergies. Laundry soap, Scented products
Diagnostic Lab Data: none during end of life hospice care.
CDC Split Type:

Write-up: Stable at time of vaccine 1/15/21 and 2/5/21, Transferred to ER for pocketing food, Left facial drooping and left sided weakness on 7/4/21. Returned from hospital 7/14/21 w/gastrostomy nutritional status and hospice care. She expired w/end of life hospice care in place on 7/15/21.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1491031

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