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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1044969

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Case Details

VAERS ID: 1044969 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:2020-12-31
Onset:2021-01-07
   Days after vaccination:7
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, SARS-CoV-2 test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 15
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: 20210107; Test Name: Rapid test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021165016

Write-up: had a positive rapid test for COVID-19/ reported to have had COVID-19 disease; This is a spontaneous report received from a contactable consumer employee of a nursing home 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 25th of 39 reports. An 87-year-old patient of unspecified gender received bnt162b2 (COMIRNATY, lot number: EM0477), via unspecified route of administration on 31Dec2020 at single dose for COVID-19 immunisation. The relevant medical history and concomitant medications were not reported. The patient was reported to have had a positive rapid test for COVID-19 on 07Jan2021. She was reported to have had COVID-19 disease. Symptoms included body temperature over 39 degrees Celsius and diarrhea. The patient died on 22Jan2021. It was not reported if the autopsy was performed. The outcome of the 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: had a positive rapid test for COVID-19/ reported to have had COVID-19 disease


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