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

This is VAERS ID 1048263



Case Details

VAERS ID: 1048263 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:2020-12-31
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Coronavirus test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-09
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: Coronavirus rapid test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021164984

Write-up: patient contractred Coronavirus; This is a spontaneous report from a contactable consumer based on information received by Pfizer from Biontech [manufacturer control number: 15873], license party for Comirnaty. The reporter reported similar events for 39 patients, this is the 15th of 39 reports. A 91-year-old patient of an unspecified gender received 1st dose of bnt162b2 (COMIRNATY, lot number EM0477), via an unspecified route of administration on 31Dec2020 at single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient contractred coronavirus (covid-19) (death) on an unspecified date. The patient underwent lab tests and procedures which included coronavirus rapid test: positive on 05Jan2021. The patient died on 09Jan2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : DE-PFIZER INC-2021164939 same reporter/drug, similar events, different patient; Reported Cause(s) of Death: patient contractred Coronavirus


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