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

This is VAERS ID 1037308



Case Details

VAERS ID: 1037308 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-07
Onset:2021-01-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Cardiovascular disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   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: Arterial hypertension; Cognitive impairment; Frailty (Dependence on Daily Living Assistance in toilet, dressing , walking); Gait disturbance
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEPFIZER INC2021150391

Write-up: Cardio-respiratory arrest; Cardiovascular disorder; This is a spontaneous report from a contactable physician downloaded from the regulatory authority -WEB BE-FAMHP-DHH-N2021-76127. An 84-year-old female patient received the first dose of bnt162b2 (COMIRNATY) (lot number EM0477), via an unspecified route of administration at single dose on 07Jan2021 for Covid-19 immunisation. Medical history included hypertension, cognitive impairment, walking disorders, recurrent falls - frailty: dependence on daily living assistance in toilet, dressing , walking. Concomitant medications were not reported. On 26Jan2021, the patient experienced cardio-respiratory arrest, cardiovascular disorder with fatal outcome. The patient died on 26Jan2021. It was not reported if an autopsy was performed. Reporter''s comment: Treatment: no Evolution of the ADR - Death Situations - Other: Probably not related to the vaccine The person did not have any particular reaction to the vaccination. Death occurred unexpectedly 19 days after the first dose of Pfizer BioNtech vaccine. No follow-up attempts possible. No further information expected.; Reporter''s Comments: Treatment - No Evolution of the ADR - Death Situations - Other: Probably not related to the vaccine The person did not have any particular reaction to the vaccination. Death occurred unexpectedly 19 days after the first dose of Pfizer BioNtech vaccine.; Reported Cause(s) of Death: Cardiovascular disorder; Cardio-respiratory arrest


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