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

This is VAERS ID 1048265



Case Details

VAERS ID: 1048265 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:2020-12-31
Onset:2021-01-07
   Days after vaccination:7
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: Coronavirus infection, Dysphagia, SARS-CoV-2 test, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   Days after onset: 8
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: 20210107; Test Name: COVID-19 Quick test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021165011

Write-up: Coronavirus infection; Swallowing disorder; COVID-19 quick test positive; This is a spontaneous report received from a contactable employee of a nursing home 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 23th of 39 reports. A 90-year-old (at time of vaccination) patient of an unspecified gender received first dose of bnt162b2 (COMIRNATY, Lot number: EM0477) via an unspecified route of administration on 31Dec2020 at single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient experienced coronavirus infection and swallowing disorder on an unspecified date. Patient had COVID-19 quick test positive on 07Jan2021. Outcome of "Coronavirus infection" was fatal, of other events was unknown. The patient died on 15Jan2021. It was unknown 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 patients; Reported Cause(s) of Death: Coronavirus infection


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