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

This is VAERS ID 1044967



Case Details

VAERS ID: 1044967 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:2020-12-31
Onset:2021-01-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-08
   Days after onset: 3
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:
Allergies:
Diagnostic Lab Data: Test Date: 20210105; Test Name: COVId-19 rapid test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021164988

Write-up: Died/ cause of death was not reported; Corona disease/ COVId-19 rapid test positive; This is a spontaneous report from a contactable consumer based on information received by Pfizer from Biontech Manufacturer control number: 15873, license party for Comirnaty. This reporter reported similar events for 39 patients. This is the 18th of 39 reports. An approximately 90 years old patient of unspecified gender received bnt162b2 (COMIRNATY, lot number: EM0477), via unspecified route of administration on 31Dec2020 at single dose for COVID-19 vaccination. The Patient experienced Corona disease. A COVID rapid test was positive on 05Jan2021. Patient died on 08Jan2021. The patient had no symptoms. The cause of death was not reported. It was unknown if autopsy was done. The outcome of the event corona disease/ COVId-19 rapid test positive was unknown, while the other event was fatal. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : DE-PFIZER INC-2021164939 same reporter/product, similar event, different patient; Reported Cause(s) of Death: Died/ cause of death was not reported


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