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

This is VAERS ID 1044977



Case Details

VAERS ID: 1044977 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2020-12-31
Onset:2021-01-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 1 - / OT

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: 2021-01-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 (Patient concurrent conditions included General physical health deterioration, COVID-19.); General physical health deterioration (Patient concurrent conditions included General physical health deterioration.); Living in nursing home (there was a covid-19 outbreak among several residents and staff.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 virus test; Test Result: Positive
CDC Split Type: DKPFIZER INC2021158646

Write-up: Death. It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient .; COVID-19; This is a spontaneous report received from a contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is DK-DKMA-WBS-0032135. A 79-years-old female patient received first dose of bnt162b2 (COMIRNATY, lot number: EJ6797), intramuscular on 31Dec2020 at single dose for covid-19 immunisation. Medical history included general physical health deterioration, COVID-19 and the patient was living in nursing home, where there was a covid-19 outbreak among several residents and staff, all ongoing. The patient''s concomitant medications were not reported. On 03Jan2021 the patient developed Death. No treatment due to the death was reported. Reported causes of death: death and of/with COVID-19. Only normal confirmation of death was performed post mortem. The patient underwent lab tests and procedures which included COVID-19 virus test: positive on Jan2021. The patient died on 03Jan2021. An autopsy was not performed. The reporter stated that it was not inconceivable that the total liability of Covid-19 disease and the vaccination had been fatal for the patient. Sender Comment: Comment from Agency: Version 001 has not been submitted to Regulatory Authority. Health Authority should therefore consider version 2 as the initial report. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: COVID-19; Death


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