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

This is VAERS ID 1048271



Case Details

VAERS ID: 1048271 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2020-12-31
Onset:2021-01-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-06
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALENDRONAT SANDOZ; ARICEPT; BETOLVEX [CYANOCOBALAMIN-TANNIN COMPLEX]; METFORMIN ACTAVIS; VISCOTEARS; VITAMIN D [COLECALCIFEROL]
Current Illness: COVID-19; Feverish; General physical health deterioration; Hyperthyroidism; Living in nursing home (there was a covid-19 outbreak among several residents and staff.); Renal impairment (One functional kidney); Urinary infection
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia Alzheimer''s type; Dry eyes; Osteoporosis; Type 2 diabetes mellitus; Vitamin B12 deficiency
Allergies:
Diagnostic Lab Data: Test Date: 20210103; Test Name: COVID-19 virus test; Test Result: Positive
CDC Split Type: DKPFIZER INC2021158642

Write-up: Death. It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient .; COVID-19 virus test positive; This is a spontaneous report downloaded from the Medicines Agency (MA) Regulatory Authority-WEB [DK-DKMA-WBS-0032137]. Safety Report Unique Identifier DK-DKMA-ADR 24693268. The case was received from a contactable physician via The Medicines Agency (MA). An 87-year-old female patient received first dose of bnt162b2 (COMIRNATY, Batch number: EJ6797, Expiration Date: 30Apr2021) intramuscular on 31Dec2020 at single dose for covid-19 immunization. Medical history included Osteoporosis, Dementia Alzheimer''s type, Vitamin B12 deficiency, Type 2 diabetes mellitus, Dry eyes, General physical health deterioration, COVID-19, Feverish, Urinary infection, Hyperthyroidism, Renal impairment (One functional kidney) and the patient was living in nursing home (there was a covid-19 outbreak among several residents and staff). Concomitant medications include alendronate sodium (ALENDRONAT SANDOZ) for Osteoporosis from 24Apr2020, donepezil hydrochloride (ARICEPT) from 17Jun2019 for dementia Alzheimer''s type, cyanocobalamin-tannin complex (BETOLVEX) since 20Oct2014 for Vitamin B12 deficiency, metformin hydrochloride (METFORMIN ACTAVIS) from 11Mar2020 for Type 2 diabetes mellitus, carbomer (VISCOTEARS) from 28Aug2019 for dry eyes, colecalciferol (VITAMIN D) from 30Apr2020 for Osteoporosis. Past vaccinations included PNEUMOVAX (Pneumococcal vaccine, 23-valent) (batch number: S014391) and FLUZONE (Influenza Type A and Influenza Type B vaccine, 3-valent) (batch number: UJ459AB). Past drug included OXYGEN in Apr2020. On 31Dec2020, the patient was vaccinated with COMIRNATY first dose (Batch number: EJ6797) dosed 1 DF for COVID-19 immunization. The patient got unwell on 02Jan2021 and had COVID-19 virus test positive on 03Jan2021. The patient did not need respirator but quickly gets very unwell. Receives palliative treatment with oxygen and Imacilin (AMOXICILLIN) due to mucus accumulation. Patient death occurred on 06Jan2021. Reported cause(es) of death: Death and of/with COVID-19. Only normal confirmation of death was performed. No findings were reported. Causality: It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Death. It is not inconceivable that the total liability of Covid-19 disease and the vaccination has been fatal for the patient .


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