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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1104935



Case Details

VAERS ID: 1104935 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-15
Onset:2021-02-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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: Arterial hypertension (treated with ramipril); Hypothyreosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021267505

Write-up: died with unknown cause; This is a spontaneous report downloaded from the Agency; Regulatory Authority-WEB [DE-PEI-CADR2021021478]. A non-contactable consumer reported that an 81-year-old female patient received BNT162B2 (COMIRNATY/ mRNA TOZINAMERAN; solution for injection; Lot number: unknown), intramuscular on 15Feb2021 at single dose for COVID-19 immunisation. The patient''s medical history included ongoing arterial hypertension (treated with ramipril) and ongoing hypothyreosis (treated). Concomitant medications were not reported. It was reported that, on 20Feb2021, the patient died with unknown cause. It was unknown if an autopsy was performed or not. The event was assessed as serious (death). The outcome of the event was reported as fatal. Health Authority Comment: Information on risk factors or previous illnesses: Arterial hypertension treated with ramipril treated hypothyroidism / unclear cause of death". No follow-up attempts are possible, information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: died with unknown cause


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