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

This is VAERS ID 1046666



Case Details

VAERS ID: 1046666 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-02-20
Onset:2021-02-20
   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 EN5318 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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: N/A
Current Illness: None
Preexisting Conditions: Heart and artery diseases
Allergies: KNDA
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Patient had no adverse events during the observation period after vaccine. He was conscious and having conversation with facility staff. He was observed for 15 minutes at least. When the facility staff returned later, approximately 60 to 90 minutes, patient had passed away.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1046666

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