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From the 7/16/2021 release of VAERS data:

This is VAERS ID 996105



Case Details

VAERS ID: 996105 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-23
Onset:2021-01-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   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: Levothyroxine, senna, multivitamins, aspirin and possible hospice medications
Current Illness: Dementia, hypothyroidism, coronary artery disease, patient was already on hospice, so unclear if vaccine related . Pt was at her baseline until she passed away
Preexisting Conditions: Dementia, hypothyroidism, coronary artery disease, HTN, multiple other medical issues
Allergies: Egg, co-trimoxazole, Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: patient received vaccine on Jan 23, 2021 passed away on Jan 24, she was already on hospice, so unclear if due to vaccine or other issues. Was at her baseline before and after vaccine per facility, had b''fast and passed away at noon on Jan 24


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