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

This is VAERS ID 1089840



Case Details

VAERS ID: 1089840 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-13
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6789 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021250310

Write-up: Death; This is a spontaneous report from a non-contactable physician, downloaded from the Regulatory Agency-WEB DE-PEI-PEI2021003112. A 77-year-old female patient received BNT162B2 (COMIRNATY) via an unspecified route of administration on 13Feb2021 (Batch/lot no: EJ6789) at single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient experienced death on an unspecified date. It was not reported if an autopsy was performed. The cause of death was not reported. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: unknown cause of death


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