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

This is VAERS ID 1082415



Case Details

VAERS ID: 1082415 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4244/PF/IM / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Cough, Death, Pulmonary function test, Respiratory acidosis, Respiratory failure, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: COPD; Respiratory failure
Allergies:
Diagnostic Lab Data: Test Name: Respiratory test; Result Unstructured Data: Test Result:non infective exacerbation of COPD and respiratory; Comments: revealed non infective exacerbation of COPD and respiratory acidosis; Test Date: 20210226; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:no - negative covid-19 test
CDC Split Type: GBPFIZER INC2021239390

Write-up: type 2 respiratory failure; respiratory acidosis; cough; non infective exacerbation of COPD; Death; This is a spontaneous report from a contactable physician. This is a report received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202103021834112350, and Safety Report Unique Identifier is GB-MHRA-ADR 24864762. A 70-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), lot number: EK4244/PF/IM, via an unspecified route of administration on an unspecified date in 2021 at single dose for COVID-19 immunisation. Medical history included respiratory failure and COPD (chronic obstructive pulmonary disease). Patient has not had symptoms associated with COVID-19 and patient was not enrolled in clinical trial. The patients concomitant medications were not reported. The patient experienced type 2 respiratory failure on an unspecified date, respiratory acidosis on an unspecified date, cough on an unspecified date, death on 01Mar2021 also reported as 24Feb2021 and non-infective exacerbation of COPD on an unspecified date. It was reported that patient had moderate COPD but had good quality of life. She was well through shielding time from Mar2020 until Feb2021.She had vaccine and 12 days later developed chesty cough. Collapsed two days later and was admitted to ITU with type 2 respiratory failure and died 3 days later. Patient never previously had a COPD related hospital admission. Patient has not tested positive for COVID-19 since having the vaccine. ITU tests (respiratory test) revealed non infective exacerbation of COPD and respiratory acidosis. The patient underwent lab tests and procedures which included COVID-19 virus test: no - negative covid-19 test on 26Feb2021, and respiratory test: revealed non infective exacerbation of COPD and respiratory acidosis on an unspecified date. The outcome of the events was fatal. The patient died on 01Mar2021 also reported as 24Feb2021. 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: type 2 respiratory failure; respiratory acidosis; cough; death; non-infective exacerbation of COPD


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