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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1045455

Case Details

VAERS ID: 1045455 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram head, SARS-CoV-2 test, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: Chronic bronchitis; Diabetes mellitus non-insulin-dependent; Heart failure; Insufficiency renal (moderate renal insufficiency)
Preexisting Conditions: Medical History/Concurrent Conditions: Agitated (Patient was improving, but to what extent by which day is not clear); Bladder infection; Breast ductal carcinoma (declared "clean" in same year as diagnosis); Confusion (Patient was improving, but to what extent by which day is not clear); Consciousness decreased (Patient was improving, but to what extent by which day is not clear); Food refusal; Thrombosis leg
Diagnostic Lab Data: Test Date: 20210127; Test Name: CT scan (brain); Result Unstructured Data: Test Result:unknown result; Comments: sent home; Test Date: 20210127; Test Name: COVID-19 test; Result Unstructured Data: Test Result:negative
CDC Split Type: NLPFIZER INC2021158436

Write-up: Her death on 05Feb2021 unexpected; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB, Regulatory authority number NL-LRB-00441023. A 93-year-old female patient received BNT162B2 (COMIRNATY, Lot number: EJ6134) at single dose for COVID-19 immunization on 02Feb2021. Medical history included Breast ductal carcinoma in 1999 (declared "clean" in same year as diagnosis), chronic bronchitis, diabetes mellitus non insulin dependent, insufficiency renal, thrombosis leg, heart failure, bladder infection (Urinary tract infection) since 24Jan2021, confusion, agitated on 25Jan2021, food refusal, consciousness decreased since 27Jan2021. Relevant concomitant drugs were unknown. Past drug therapy included glimepiride tablet 1mg for Non-insulin-dependent diabetes mellitus, metformin tablet 500mg for Non-insulin-dependent diabetes mellitus, rivaroxaban tablet 20mg, pantoprazole tablet gastro-resistant 20mg, metoprolol tablet 100mg, isosorbide mononitrate tablet 20mg, ramipril tablet 10mg, bumetanide, beclerolometasone / formoterolometasone / formoterolometasone powder 100 / 6ug / dose, amoxicillin / clavulanic acid tablet 500 / 125mg, Xarelto for DVT prophylaxis, Foster inhalatie powder 100/6UG/DOSE, promocard, augmentin for Urinary tract infection since 24Jan2021. This 93-year old woman living indecently, with her daughter, needed more care over the past 3 months, but still did housework herself, eg ironing. Nine days prior to vaccination patient had fell ill, suspected urinary tract infection treated with amoxicillin / clavulan. Next day (GP home visit): confused and agitated., 2 days after (6 days prior to vaccination) that: refuses to eat and drink (including any medication), consciousness decreased, delirium. The patient was taken to Emergency: extensively tested, including CT scan of head, COVID test negative, sent home. 2 days later (4 days prior to vaccination) restarted taking glimeperide, xarelto, pantopraxol. As heart rhythm and blood pressure stayed within limits other medication not restarted at this point. Patients condition fluctuates but got increasingly better, back to eating lunch at the table. Day after vaccination was a good day and physician proposed to lower the frequency of house calls. Day 3 after vaccination found death (sudden death). Physician''s opinion on relationship with vaccination: ''we will never know''. Comments: This 93 year old was vaccinated with the Pfizer vaccine on 2-2-2021. (batch number: EJ6134) Her death on 05Feb2021 unexpectedly. She was a 93 year old woman living independently together with her daughter, single. In 1999 duct carcinoma and 1999 declared ''clean''. For years chronic bronchitis, requiring inhalation therapy. Also known with diabetes mellitus 2 and moderate renal insufficiency. Leg thrombosis and decompensation Cordis. Some inconveniences not contributing further. Medication: glimepiride and metformin. Xarelto and pantoprazole. Metoprolol, promocard, ramipril and bumetanide.Foster inhalation. On 24Jan she became ill and got augmentin from the General practice center doctor due to an alleged bladder infection. She became more in need of care in the last 3 months but did some things herself such as ironing. 25Jan home visit, confused and angry. 26Jan staying at home and letting nature take its course. 27Jan drinking and not eating and not being able to take medication. Emergency department assessment: Delirium, lowered consciousness. Completely checked up to CT brain with unknown result, Covid (-). Back home to fix up. 29Jan restart on the basis of the blood sugars glimepiride and xarelto. Pantoprazole also Other medications based on blood pressure and pulse. Because these values remained good, no restart has been done. The days after changing getting better and at the table before lunch. 03Feb suggested a good day and reduction of home visits. Vaccinated the day before. (EJ6134) Found 05Feb dead in the morning. You can see from the report that she was recovering. I dare not say whether the vaccine was the cause. Years ago an 80-year-old woman was vaccinated (flu), who was found dead and healthy the next day. I then passed that case on to regulatory authority. Conclusion: We will never know whether the death was caused by the vaccination. The woman had been ill. Died not following the vaccination. Hence my report, so that you and society can benefit from it. Don''t register, you don''t know. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: We will never know whether the death was caused by the vaccination. The woman had been ill. Died not following the vaccination. Hence my report, so that you and society can benefit from it. Don''t register, you don''t know.; Reported Cause(s) of Death: Sudden death

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