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

This is VAERS ID 1099582



Case Details

VAERS ID: 1099582 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-02-01
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dehydration, Disturbance in attention, Dyspnoea, Pneumonia bacterial
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 4
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: Dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021256441

Write-up: Dyspnoea; Vigilance decreased; Pneumonia bacterial; Exsiccosis; This is a spontaneous report from a non-contactable physician received from regulatory authority, downloaded from the Agency, DE-PEI-PEI2021003160. A 98-year-old female patient received BNT162B2 (COMIRNATY, batch/lot number: EM0477) via an unspecified route of administration on an unspecified date (unknown age at vaccination) at single dose for COVID-19 immunization. The patient''s medical history included dementia and unknown if ongoing. Before vaccination there are no typical symptoms of infections; the patient was stable. Concomitant medications were not reported. After vaccination, on 01Feb2021 the patient developed dyspnea, vigilance decreased, exsiccosis, and pneumonia bacterial, lasting for unknown. The condition was life threatening. The patient died on 05Feb2021. It was not reported if an autopsy was performed. The outcome of the events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death:


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