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

This is VAERS ID 1000479



Case Details

VAERS ID: 1000479 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-01-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1484 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure, Condition aggravated, Continuous positive airway pressure, Death, Dyspnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Medical History/Concurrent Conditions: Atrial fibrillation; Cardiac failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEPFIZER INC2021097900

Write-up: Cardiac failure aggravated; breathing difficulties; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB. The regulatory authority report number is SE-MPA-2021-001654 and other case identifier number SE-MPA-1611657205772. An 89-year-old female patient received BNT162B2 (COMIRNATY; Lot number EL1484), intramuscular in Jan2021 as single dose for covid-19 immunization. Medical history included cardiac failure from an unknown date and unknown if ongoing and atrial fibrillation from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced cardiac failure aggravated in Jan2021, which was serious as it lead to death. The patient also experienced breathing difficulties in Jan2021, with unknown outcome. Details were as follows: patient had palliative care prescriptions since Apr2020, but was sent to hospital with breathing difficulties three days after the vaccination and died the same day. The patient was treated with CPAP (continuous positive airway pressure) and intravenous diuretic at the hospital. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Cardiac failure aggravated


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