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

This is VAERS ID 1044959



Case Details

VAERS ID: 1044959 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-25
Onset:2021-01-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9788 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Death, General physical condition abnormal, SARS-CoV-2 test
SMQs:, Guillain-Barre syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   Days after onset: 1
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: COVID-19 (only minor symptoms); COVID-19 virus test positive
Allergies:
Diagnostic Lab Data: Test Date: 20201223; Test Name: COVID-19 virus test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021160564

Write-up: Exitus letalis; Deterioration in general condition; Weakness; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority-WEB DE-PEI-PEI2021002518 and received via Regulatory Authority. A 90-years-old male patient received his first dose of bnt162b2 (COMIRNATY), lot number: EK9788, intramuscular on 25Jan2021 at single dose for covid-19 immunisation. Medical history included covid-19 from 13Jan2021 and unknown if ongoing with only minor symptoms, COVID-19 virus test positive on 23Dec2020. The patient''s concomitant medications were not reported. On 26Jan2021 after vaccination the patient developed Deterioration in general condition and Weakness and experienced exitus letalis (as reported) on 27Jan2021. The patient underwent lab tests and procedures which included COVID-19 virus test: positive on 23Dec2020. The patient died on 27Jan2021. The outcome of events Deterioration in general condition and Weakness was fatal. An autopsy was not performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Exitus letalis; Deterioration in general condition; Weakness


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