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

This is VAERS ID 1045000

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Case Details

VAERS ID: 1045000 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2020-12-29
Onset:2021-01-05
   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 - / 1 - / -

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: 2021-01-25
   Days after onset: 20
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; Test Result: Positive
CDC Split Type: ESPFIZER INC2021163688

Write-up: COVID-19; This is a spontaneous report from a contactable consumer. This report was downloaded from Medicines Agency (MA) regulatory authority-WEB and received via Regulatory Authority ES-AEMPS-735202. An elderly (over 65 years old) male patient received the 1st dose bnt162b2 (COMIRNATY) , via an unspecified route of administration on 29Dec2020 at single dose for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced covid-19 (positive for COVID-19) on 05Jan2021 with outcome of fatal. The patient died on 25Jan2021. It was not reported if an autopsy was performed. The cause of death was covid-19. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: COVID-19


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