From the 12/27/2024 release of VAERS data:

This is VAERS ID 998138

Government Disclaimer on use of this data

Case Details

VAERS ID:	998138 (history)
Form:	Version 2.0
Age:	86.0
Sex:	Female
Location:	Florida

Vaccinated:	2021-01-22
Onset:	2021-01-22
Days after vaccination:	0
Submitted:	0000-00-00
Entered:	2021-02-03

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	- / 2	RA / IM

Administered by: Senior Living Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Headache, Neck pain, Pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-26
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: Daughter unaware of prescriptions
Current Illness: Was hospitalized in December for testing positive for COVID 12/18/2020 - hospitalized for 4 days then released back to nursing home facility.
Preexisting Conditions: Type 2 diabetes; high blood pressure
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Same day as vaccination given, developed pain went from arm up to shoulder, to back, to neck to head - right side of body; chills/body aches

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=998138