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

This is VAERS ID 1044940



Case Details

VAERS ID: 1044940 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-21
Onset:2021-01-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiovascular disorder
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   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: EVISTA; SIPRALEXA; LIPITOR [ATORVASTATIN]; ASAFLOW; L-THYROXIN [LEVOTHYROXINE]; OMEPRAZOLE; MOVICOL NEUTRAL; DAFALGAN FORTE; TARDYFERON; BURINEX; LORMETAZEPAM; RAMIPRIL; BRILIQUE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Brain lesion; Dementia; Gamma nail fixation (the right hip after a fall on 29Dec2020); Non ST segment elevation myocardial infarction; STEMI
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEPFIZER INC2021158453

Write-up: Cardiovascular problem; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB BE-FAMHP-DHH-N2021-76210. An 88-year-old female patient received first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 21Jan2021 at single dose for COVID-19 Vaccination. Medical history included non-STEMI, STEMI, a gamma nail on the right hip after a fall (the right hip after a fall on 29Dec2020), extensive vascular ischemic cerebral lesions and dementia. Concomitant medication included raloxifene hydrochloride (EVISTA), escitalopram oxalate (SIPRALEXA), atorvastatin (LIPITOR), acetylsalicylic acid (ASAFLOW), levothyroxine (L-THYROXIN) , omeprazole, macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOL NEUTRAL), paracetamol (DAFALGAN FORTE), ferrous sulfate (TARDYFERON), bumetanide (BURINEX), lormetazepam, ramipril and ticagrelor (BRILIQUE). The patient experienced cardiovascular problem (death) on 30Jan2021. The patient died of cardiovascular problem on 30Jan2021. It was not reported if an autopsy was performed. Comirnaty/ Sudden death/ Agency (WHO)/ unclassifiable. Reporter''s comments: Treatment - No. Evolution of the ADR - Died. Situations - Other: administration - no direct causation suspected at present. The patient received the first vaccination on 21Jan2021. On 30Jan2021, she was found dead in bed by the nursing staff of the rest home where she was staying during the week round. No complaints were registered between the administration of the vaccination and the date of death. No follow-up attempts possible. No further information expected, information about lot/batch number cannot be obtained.; Reporter''s Comments: Treatment - No. Evolution of the ADR - Died. Situations - Other: administration - no direct causation suspected at present. The patient received the first vaccination on 21Jan2021. On 30Jan2021, she was found dead in bed by the nursing staff of the rest home where she was staying during the week round. No complaints were registered between the administration of the vaccination and the date of death.; Reported Cause(s) of Death: Cardiovascular problem


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