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

This is VAERS ID 1014909



Case Details

VAERS ID: 1014909 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-12
Onset:2021-01-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic valve insufficiency; Cardiac insufficiency; Chronic pain; Parkinson''s disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021103804

Write-up: Sudden death; This is a spontaneous report from a non-contactable physician downloaded from the Medicines Agency (EMA) EudraVigilance-WEB [DE-PEI-PEI2021001842]. A 87-year-old female patient received first dose of BNT162B2 (COMIRNATY) Lot number EM0477, on 12Jan2021 at single dose for COVID-19 immunisation. Medical history included: Parkinson''s disease, Aortic valve insufficiency, Cardiac insufficiency, Chronic pain, all unknown if ongoing. Concomitant medication was not reported. 12 day(s) after vaccination (24Jan2021) the patient developed Death sudden. The patient was dead. Death cause was reported as Sudden death. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Sudden death


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