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From the 11/12/2021 release of VAERS data:

This is VAERS ID 959147

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Case Details

VAERS ID: 959147 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Ohio  
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Jaundice
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alzheimer''s disease, Type 2 with chronic kidney disease,
Preexisting Conditions: copd, Depression,psychosis,atherosclerotic heart disease
Allergies: penicillin
Diagnostic Lab Data: none as resident was comfort care only
CDC Split Type:

Write-up: Unknown as to any correlation with vaccine as this was a hospice patient that was already experiencing decline. Patient became Jaundice for approximately one week prior to expiring.

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