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

This is VAERS ID 1010264



Case Details

VAERS ID: 1010264 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-06
Onset:2021-01-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BISOHEXAL; FENTANYL; NOVAMINSULFON
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac insufficiency; Coronary heart disease; Hypertension arterial; Stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021098157

Write-up: Sudden death chronologically related to vaccination; Another stroke was suspected to be the cause of death; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority-WEB DE-PEI-PEI2021001650. A 95-year-old female patient was vaccinated with the first dose of BNT162B2 (COMIRNATY, lot number was not reported) via an unspecified route of administration on 06Jan2021 at a single dose for COVID-19 immunisation. Medical history included Stroke with hemiparesis, Cardiac insufficiency, Coronary heart disease, Hypertension arterial. Concomitant medications included bisoprolol fumarate (BISOHEXAL), novaminsulfon and fentanyl. The patient developed Death sudden and Accident cerebrovascular after 4 days vaccination. Death cause was reported as Accident cerebrovascular. It was reported an autopsy was not performed. Causality between the event and product was indeterminate. No follow-up attempts possible; information regarding batch/lot cannot be obtained.; Reported Cause(s) of Death: Accident cerebrovascular


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1010264

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