From the 3/29/2024 release of VAERS data:

This is VAERS ID 1784945

Government Disclaimer on use of this data

Case Details

VAERS ID:	1784945 (history)
Form:	Version 2.0
Age:	12.0
Sex:	Female
Location:	South Carolina

Vaccinated:	2021-07-11
Onset:	2021-08-02
Days after vaccination:	22
Submitted:	0000-00-00
Entered:	2021-10-14

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	EW0179 / 1	UN / SYR

Administered by: Private Purchased by: ?
Symptoms: Death, Respiratory tract haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-08-02
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Trisomy 18, Scoliosis, Closed Ventricular Septal Defect, Ectopic Kidney, Gastrostomy Tube dependent, GERD, and Obstructive Sleep Apnea
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood in airway, Death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1784945