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

This is VAERS ID 1064709



Case Details

VAERS ID: 1064709 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-08
Onset:2021-02-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6789 / 2 LA / 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: 2021-02-13
   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: AFib; Alzheimer''s disease; Arrhythmia
Allergies:
Diagnostic Lab Data: Test Date: 20201217; Test Name: COVID 19; Result Unstructured Data: Test Result:unknown results
CDC Split Type: FRPFIZER INC2021197583

Write-up: Sudden death; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB FR-AFSSAPS-RN20210481. An 83-year-old female patient received second dose of bnt162b2 (COMIRNATY, batch/lot #: EJ6789), intramuscular on 08Feb2021 at single dose at left arm for covid-19 immunisation. Medical history included dementia Alzheimer''s disease, complete arrhythmia due to AFib from an unknown date and unknown if ongoing, and patient had no history of covid-19. The patient''s concomitant medications were not reported. No biological assessment or clinical examination done recently because patient was doing well. The patient experienced sudden death on 13Feb2021, his death was declared at 9:30 am. The patient underwent lab tests and procedures which included COVID 19 test on 17Dec2020. No autopsy was performed. No follow-up attempts are possible, batch number already obtained.; Reported Cause(s) of Death: Sudden death


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