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

This is VAERS ID 1064584



Case Details

VAERS ID: 1064584 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-26
Onset:2021-02-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 LA / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   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: Medical History/Concurrent Conditions: Anxiety aggravated (before the vaccination, recently lost his wife); Asthma; COPD; COVID-19 (Had Covid-19. Test on 21Oct2020.); Dementia; Hypertension arterial
Allergies:
Diagnostic Lab Data: Test Date: 20201021; Test Name: COVID-19 test; Result Unstructured Data: Test Result:Had Covid-19
CDC Split Type: FRPFIZER INC2021197527

Write-up: Death NOS; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) regulatory authority, regulatory authority report number FR-AFSSAPS-BX20210769. A 94-year-old male patient received first dose of bnt162b2 (COMIRNATY, lot number: EJ6788), intramuscularly on left arm on 26Jan2021 at single dose for COVID-19 immunization, oxazepam (SERESTA) orally from 04Feb2021 to 06Feb2021 at 10 mg, twice daily for anxiety attack. Medical history included asthma , had Covid-19 (Test on 21Oct2020), dementia, hypertension arterial, chronic obstructive pulmonary disease, patient in an institution who recently lost his wife, increased ambulation and anxiety before the vaccination, significant anxiety crisis on 04Feb2021. In this context, treatment with oxazepam 10 mg twice a day for two days. No psychotropic treatment. The patient''s concomitant medications were not reported. The patient was found dead in bed on 06Feb2021 04:15 am. The action taken in response to the event for oxazepam was not applicable. The patient died on 06Feb2021. 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: Death NOS


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