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

This is VAERS ID 1037372



Case Details

VAERS ID: 1037372 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-26
Onset:2021-01-31
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   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: XARELTO
Current Illness: Living in nursing home
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac failure; Chronic respiratory failure; Oxygen supplementation (oxygen dependence)
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021151098

Write-up: Death / found dead; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) -WEB (Regulatory Authority number FR-AFSSAPS-BX20210488). A 97 years old female patient received the first single dose of BNT162B2 (COMIRNATY; lot EJ6795) intramuscular, in right arm, on 26Jan2021, for COVID-19 vaccination. Medical history included chronic respiratory failure, cardiac failure and oxygen supplementation (oxygen dependence), all from an unknown date and unknown if ongoing. The patient was living in nursing home. Concomitant medication included rivaroxaban (XARELTO). The patient did not have Covid-19 before vaccination, had not been tested. The vaccination was done without immediate adverse effects, no noticeable event in the following days (no fever, no symptoms of an infectious process, no respiratory symptoms, no decompensation of the underlying diseases). The patient was found dead in the morning on 31Jan2021, 5 days after vaccination. Cause of death was unknown. It was unknown if an autopsy was done. NB: imputation made without prejudice to the elements of investigations which could be carried out within the framework of legal or amicable compensation procedures. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: unknown cause of death


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