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

This is VAERS ID 1045007



Case Details

VAERS ID: 1045007 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-27
Onset:2021-01-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: General physical health deterioration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: THYROXIN; FRAGMIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Hypertension; Pancreatic cancer metastatic
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIPFIZER INC2021159024

Write-up: General physical health deterioration/The general well-being deteriorated rapidly; This is a spontaneous report from a non-contactable other healthcare professional downloaded from the Medicines Agency (MA) Regulatory authority-WEB FI-FIMEA-20210542. An 80-year-old female patient receive BNT162B2 (COMIRNATY, lot number was EJ6134 and expiration date was unknown) via intramuscular on 27Jan2021 at single dose for COVID-19 vaccination. Medical history included extensive metastatic pancreas cancer diagnosed in Dec2020, flimmer (atrial fibrillation) and hypertension (HTA). Patient received palliative care policy. Concomitant medication included levothyroxine sodium (THYROXIN) and dalteparin sodium (FRAGMIN). Patient had general physical health deterioration on 27Jan2021. The general well-being deteriorated rapidly from the day of vaccination (27Jan2021), although even before that the general well-being had decreased. The patient died due to general well-being deteriorated on 30Jan2021. It was not reported if an autopsy was performed. The outcome of event was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: General physical health deterioration/The general well-being deteriorated rapidly


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