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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1065049

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Case Details

VAERS ID: 1065049 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-02-06
   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 EJ6134 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MIDAZOLAM; MORFINE
Current Illness: COPD; Emphysema pulmonary
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210206; Test Name: COVID-19; Result Unstructured Data: Test Result:positive
CDC Split Type: NLPFIZER INC2021191175

Write-up: COVID-19; This is a spontaneous report received from a contactable physician, downloaded from the Regulatory Authority NL-LRB-00444454. A 90-year-old female patient received bnt162b2 (COMIRNATY) (Lot # EJ6134), via an unspecified route of administration at single dose on 29Jan2021 for covid-19 immunisation. Medical history included ongoing chronic obstructive pulmonary disease, ongoing emphysema. Concomitant medication included midazolam, morfine. The patient experienced Covid-19 on 06Feb2021 with fatal outcome. The patient died on 12Feb2021. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 06Feb2021. It was not reported if an autopsy was performed. The patient died at home using palliative sedation as a result of complications from Covid-19. Unknown if there was a relationship with vaccination with Comirnaty. Clinical course as follows: 5 days after vaccination, the patient experienced symptoms of a Covid-19 infection, 8 days after vaccinations the patient had a positive SARS COV 2 test and 14 days after vaccination the patient deceased with palliative sedation. The patient died of complications of a Covid-19 infection. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: complications of COVID19


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