From the 4/26/2024 release of VAERS data:

This is VAERS ID 919108

Government Disclaimer on use of this data

Case Details

VAERS ID:	919108 (history)
Form:	Version 2.0
Age:	100.0
Sex:	Female
Location:	New York

Vaccinated:	2020-12-22
Onset:	2020-12-23
Days after vaccination:	1
Submitted:	0000-00-00
Entered:	2021-01-04

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	F10140 / UNK	- / IM

Administered by: Senior Living Purchased by: ?
Symptoms: Blood culture, Culture urine, Full blood count, Malaise, Pyrexia, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-03
Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UA. C&S, CBC/Blood culture 1/2/2021
CDC Split Type:

Write-up: Fever, Malaise

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919108