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From the 11/19/2021 release of VAERS data:

This is VAERS ID 974422

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Case Details

VAERS ID: 974422 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Maryland  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Decreased appetite, Mental impairment, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: depakote, seroquel, aspirin, loratidine, prilosec, senna plus, vitamin D, gabapentin
Current Illness: none
Preexisting Conditions: dementia with behaviors, GERD. H/o HTN and diabetes in past
Allergies: none
Diagnostic Lab Data: none-family wanted no medical testing
CDC Split Type:

Write-up: Patient developed fever to 102 within 24 hours with decreased mentation. Stopped eating/drinking despite aggressively treating fever. Was DNR B status. Family agreed to a trial of IV fluids on 1/21 but was not successfully started until 1/22 after several attempts. Family wanted only comfort measures with no transfer to hospital. Patient continued to have fevers to 102-103 range. Patient passed on 1/23 . Patient did test positive for COVID in early September without significant illness. She was in usual state of health prior to vaccination.

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