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

This is VAERS ID 998175



Case Details

VAERS ID: 998175 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-07
Onset:2021-01-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol succinate ER tab ER 24hr 100mg PO daily Milk of Magnesia Suspension 400mg/5l 30ml PRN Mirtazapine 45mg tab at bedtime Clonazepam tab 0.5mg BID D-Mannose Capsule 500 MG 1 capsule daily Cranberry Tablet 450 MG 1 tablet twice daily
Current Illness: No
Preexisting Conditions: MAJOR DEPRESSIVE DISORDER, RECURRENT, SEVERE WITH PSYCHOTIC SYMPTOMS UNSPECIFIED PSYCHOSIS NOT DUE TO A SUBSTANCE OR KNOWN PHYSIOLOGICAL CONDITION MILD COGNITIVE IMPAIRMENT, SO STATED GENERALIZED ANXIETY DISORDER ESSENTIAL (PRIMARY) HYPERTENSION TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS AGE-RELATED OSTEOPOROSIS WITHOUT CURRENT PATHOLOGICAL FRACTURE OTHER ALLERGIC RHINITIS OTHER IRRITABLE BOWEL SYNDROME PNEUMONIA DUE TO CORONAVIRUS DISEASE 2019 COVID-19 BACTERIAL INTESTINAL INFECTION, UNSPECIFIED HYPOKALEMIA UNSPECIFIED SYMPTOMS AND SIGNS INVOLVING COGNITIVE FUNCTIONS AND AWARENESS OTHER SEBORRHEIC KERATOSIS HYPERLIPIDEMIA, UNSPECIFIED AGORAPHOBIA WITH PANIC DISORDER PRESENCE OF RIGHT ARTIFICIAL HIP JOINT ACQUIRED ABSENCE OF BOTH CERVIX AND UTERUS ACQUIRED ABSENCE OF OTHER ORGANS CYST OF KIDNEY, ACQUIRED NEOPLASM OF UNCERTAIN BEHAVIOR OF LIVER, GALLBLADDER AND BILE DUCTS OTHER SLEEP DISORDERS PURE HYPERGLYCERIDEMIA SPONDYLOSIS WITHOUT MYELOPATHY OR RADICULOPATHY, SITE UNSPECIFIED
Allergies: Penicillin, Pravastatin
Diagnostic Lab Data: See Above-please contact for any further questions
CDC Split Type:

Write-up: Resident vaccinated-1/7/21 Resident covid positive 1/11/21 Resident covid PNA-1/12/21 Resident hospitalized 1/16/21 Resident deceased 1/20/21


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=998175

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