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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1044970

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Case Details

VAERS ID: 1044970 (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 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   Days after onset: 10
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: Coronavirus rapid test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021165112

Write-up: Coronavirus infection identified via quick test; This is a spontaneous report based on information received by Pfizer from Biontech [manufacturer control number:15873] from a non-contactable consumer, license party for Comirnaty. A patient about 91-year-old of an unspecified gender received 1st dose of bnt162b2 (COMIRNATY, lot: EM0477), via an unspecified route of administration on 31Dec2020 at single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Patient had a positive COVID 19 quick test on 05Jan2021. The patient died on 15Jan2021. It was unknown if autopsy was done or not. Outcome of positive COVID 19 quick test was fatal. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : DE-PFIZER INC-2021165108 PFIZER INC; Reported Cause(s) of Death: Coronavirus infection identified via quick test


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