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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1075436

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Case Details

VAERS ID: 1075436 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 (COVID infection in patient''s retirement home since Jan2021)
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210128; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: ATPFIZER INC2021221795

Write-up: COVID-19 pos infection/COVID-19 respiratory infection; COVID-19 pos infection/COVID-19 respiratory infection; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB AT-BASGAGES-2021-04885. An 85-years-old female patient received first dose of bnt162b2 (COMIRNATY, lot EL1491), via an unspecified route of administration on 15Jan2021 at SINGLE DOSE for covid-19 immunisation. Medical history included exposure to COVID-19 (ongoing COVID infection in patient''s retirement home since Jan2021). The patient''s concomitant medications were not reported. The patient experienced covid-19 pos infection on 28Jan2021. The patient died on 05Feb2021 from COVID-19 respiratory infection. The patient underwent lab tests and procedures which included COVID-19 PCR test: positive on 28Jan2021. The patient died on 05Feb2021. An autopsy was not performed. BASGAGES comment: no further info available.; Reported Cause(s) of Death: COVID-19 respiratory infection

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