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

This is VAERS ID 1044968

Case Details

VAERS ID: 1044968 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Unknown  
Location: Foreign  
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Necrosis, Pain in extremity, SARS-CoV-2 test positive, Wound
SMQs:, Accidents and injuries (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-12
   Days after onset: 6
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:
Diagnostic Lab Data: Test Date: 20210106; Test Name: COVID PCR test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021165010

Write-up: Coronavirus infection; several wounds and necroses; several wounds and necroses; limb pain; positive PCR test; This is a spontaneous report from a contactable consumer. This is a report based on information received by Pfizer from Biontech, license party for Comirnaty (Biontech ticket reference number 15873). An 83-year-old patient of an unspecified gender received the first dose of BNT162B2 (COMIRNATY, lot EM0477), via an unspecified route of administration at the age of 82-year-old on 31Dec2020 at single dose for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced coronavirus infection on an unspecified date, positive PCR test on 06Jan2021, several wounds and necroses, limb pain on an unspecified date. The patient died on 12Jan2021 due to coronavirus infection. It was unknown if an autopsy was performed. The outcome of the other events was unknown. No follow-up attempts are possible. No further information is expected. ; Reported Cause(s) of Death: coronavirus infection

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