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

This is VAERS ID 1064509



Case Details

VAERS ID: 1064509 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
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 INC2021199878

Write-up: Death; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority-WEB DE-PEI-PEI2021002783. A 90-year-old male patient started to receive bnt162b2 (COMIRNATY) (batch no.: EJ6797), via an unspecified route of administration on 06Jan2021 at single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. 9 day(s) after vaccination the patient developed Death. The patient died on 14Jan2021. It was not reported if an autopsy was performed. Comirnaty/ Attending Physician / Inconsistent causal association No follow-up attempts are possible, batch number already obtained.; Reported Cause(s) of Death: Death


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