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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1039833



Case Details

VAERS ID: 1039833 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Melaena
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CARBASALAATCALCIUM; FUROSEMIDE; PANTOPRAZOL [PANTOPRAZOLE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic valve stenosis (recently diagnosed as severe and symptomatic with life expectancy between 0.5 - 1 year); Decompensation cardiac
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021158434

Write-up: Death; melaena; This is a spontaneous report received from a contactable physician downloaded from the Agency Regulatory Authority-WEB (NL-LRB-00439484). A 92-year-old female patient received BNT162B2 (COMIRNATY), via an unspecified route of administration, on 03Feb2021 at a single dose for COVID-19 immunisation. Medical history included decompensation cardiac and aortic valve stenosis (recently diagnosed as severe and symptomatic with life expectancy between 0.5 - 1 year). Concomitant medications included carbasalate calcium (CARBASALAATCALCIUM), furosemide (MANUFACTURER UNKNOWN), and pantoprazole (PANTOPRAZOL). The patient experienced melaena on 03Feb2021. The patient also experienced death on 05Feb2021, which was reported as fatal. The clinical course was reported as: The reporter described that the patient was recently diagnosed with a severe symptomatic aortic valve stenosis, with a life expectancy between 0.5 - 1 year. At time of vaccination, melaena was suspected. The patient deceased 44 hours after vaccination. The clinical outcome of melaena was unknown. The cause of death was reported as unknown. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Unknown cause of death


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