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

This is VAERS ID 1084861



Case Details

VAERS ID: 1084861 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-15
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1491 / 1 - / -

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: 2021-01-30
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiac insufficiency; COVID-19
Preexisting Conditions: Medical History/Concurrent Conditions: Viral hepatitis B
Allergies:
Diagnostic Lab Data: Test Date: 20210125; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: ATPFIZER INC2021221786

Write-up: COVID-19 respiratory infection; This is a spontaneous report a contactable physician downloaded from the Regulatory Authority [regulatory authority AT-BASGAGES-2021-04880]. The reporter reported similar events for 2 patients, this is the 1st of 2 reports. A 90-year-old female patient received the first dose of bnt162b2 (COMIRNATY, lot number EL1491) via an unspecified route of administration on 15Jan2021 at a single dose for covid-19 immunisation. The patient''s medical history included Heart failure (continuing), Viral hepatitis B, COVID-19 (continuing). The patient''s concomitant medications were not reported. The patient was positive tested for Sars-CoV2 by means of PCR (25Jan), on 30Jan2021 21:05 and died in the home from COVID-19 respiratory infection. The patient was already palliative before COVID-19 and considered as a terminal patient. No autopsy was done. Causality between the event and vaccine was assessed as unlikely by the HA. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : AT-PFIZER INC-2021242520 same reporter, same vaccine, similar events in different patient; Reported Cause(s) of Death: COVID-19 respiratory infection


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