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

This is VAERS ID 1064508



Case Details

VAERS ID: 1064508 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-06
Onset:2021-01-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-14
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021199875

Write-up: Letal death; This is a spontaneous report a non-contactable physician downloaded from the Medicines Agency (MA) regulatory authority-WEB [regulatory authority DE-PEI-PEI2021002780]. A 74-year-old female patient received the first dose of bnt162b2 (COMIRNATY) (batch/lot: EJ6797) on 06Jan2021 at a single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. 9 days after vaccination the patient developed letal death. The patient was dead on 14Jan2021. It was unknown if an autopsy was performed. Source of assessment: Attending Physician. Result of Assessment: Inconsistent causal association. No follow-up attempts possible. No further information expected. ; Reported Cause(s) of Death: Letal death


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