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

This is VAERS ID 1045021



Case Details

VAERS ID: 1045021 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-28
Onset:2021-01-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, Oxygen saturation, Oxygen saturation decreased
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APIXABAN; SERESTA; PARACETAMOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arrhythmia; Breast cancer NOS; Cardiac failure; Hypertension; Mitral valve replacement
Allergies:
Diagnostic Lab Data: Test Date: 20210129; Test Name: oxygen saturation; Test Result: 74 %
CDC Split Type: FRPFIZER INC2021160040

Write-up: Death unexplained; Oxygen saturation decreased; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) regulatory authority-WEB FR-AFSSAPS-MA20210320. A 93-year-old female patient received first dose of bnt162b2 (COMIRNATY) (lot/batch number EJ6788), intramuscular on 28Jan2021 at SINGLE DOSE for covid-19 immunization. Medical history included cardiac failure/heart failure from an unknown date and unknown if ongoing, rhythm disturbances, bio-mitral prosthesis, left breast cancer, hypertension. Patient considered to be at risk of developing a severe form of COVID-19. Patient who did not have COVID-19. Concomitant medications included apixaban, oxazepam (SERESTA), paracetamol, mirtazepam. The patient experienced death unexplained on 02Feb2021, oxygen saturation decreased (death) on 29Jan2021. Appearance of a 74% in O2 desaturation with rapid degradation of the patient during the weekend of 30-31Jan. Unconfirmed suspicion of COVID-19 (no PCR performed). The patient died on 02Feb2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death unexplained; Oxygen saturation decreased


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