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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1000401



Case Details

VAERS ID: 1000401 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-18
Onset:2021-01-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Death, Pancreatitis
SMQs:, Acute pancreatitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VENLAFAXINE; FOLIC ACID; ELIQUIS; PRAVASTATIN; OMESAR [OLMESARTAN MEDOXOMIL]; FRUSEMIDE [FUROSEMIDE]; PANTOPRAZOLE SODIUM; VITAMIN D NOS; LAMICTAL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Artificial cardiac pacemaker user; Atrial fibrillation; COVID-19; CVA; Dementia; Pancreatitis; Comments: Previous CVA ; AF + Pacemenker Dementia Previous pancreatitis 2014 ? cause Covid 19 04/2020
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEPFIZER INC2021103209

Write-up: PANCREATITIS; This is a spontaneous report from a contactable physician downloaded from the regulatory authority (IE-HPRA-2021-063633). A 91-year-old female patient received the first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 18Jan2021 at single dose for COVID-19 immunisation. Medical history included cerebrovascular accident (CVA), atrial fibrillation, artificial cardiac pacemaker user, dementia, pancreatitis in 2014 and COVID-19 from Apr2020. Concomitant medication included olmesartan medoxomil (OMESAR), lamotrigine (LAMICTAL), Vitamin D, folic acid, apixaban (ELIQUIS), frusemide (FRUSEMIDE), pravastatin, pantoprazole sodium and venlafaxine. The patient experienced pancreatitis on 20Jan2021. The patient had experienced a previous episode of pancreatitis six years prior, in 2014, the cause of which was unknown. The reporter outlined it was unclear if the pancreatitis was related to COMIRNATY. The seriousness for the event was fatal and hospitalization. The patient died in Jan2021. It was not reported if an autopsy was performed. No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected.; Reported Cause(s) of Death: PANCREATITIS


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