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

This is VAERS ID 1061850



Case Details

VAERS ID: 1061850 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-04
Onset:2021-02-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Malaise, Nausea, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: CITALOPRAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Seizure; Vascular dementia
Allergies:
Diagnostic Lab Data: Test Date: 20201021; Test Name: COVID-19 virus test; Test Result: Positive
CDC Split Type: NLPFIZER INC2021191182

Write-up: Nausea; Malaise; This is a spontaneous report downloaded from the Medicines Agency regulatory authority-WEB [Lareb (LRB) number NL-LRB-00443788] from a contactable physician. An 84-year-old male patient received bnt162b2 (COMIRNATY) (lot# EM0477), via an unspecified route of administration, on 04Feb2021, at single dose, for COVID-19 immunisation. Medical history included vascular dementia from Sep2019, seizure from 12Jan2021, COVID-19 from 21Oct2020. Concomitant medication included citalopram (unknown manufacturer). The patient experienced nausea and malaise both on 04Feb2021 with fatal outcome in Feb2021 (within 8 days after vaccination). The patient underwent lab tests and procedures which included COVID-19 virus test: positive on 21Oct2020. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Malaise; nausea


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