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

This is VAERS ID 1104949



Case Details

VAERS ID: 1104949 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-07
Onset:2021-03-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP2163 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   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: Dilated cardiomyopathy
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021272210

Write-up: Exitus letalis/ patient is dead; This is a spontaneous report downloaded from the Agency-WEB DE-PEI-PEI2021003244. A non-contactable physician reported for an 85-year-old male patient received first dose of BNT162B2 (COMIRNATY; Solution for injection; Lot Number: EP2163), via an unspecified route of administration on 07Mar2021 at single dose for COVID-19 immunisation. Medical history included dilated cardiomyopathy. The patient''s concomitant medications were not reported. On 08Mar2021, after vaccination the patient was Exitus Letalis/ patient is dead, lasting for unknown. The patient died on 08Mar2021. An autopsy was performed, and results were not provided. No follow-up attempts needed. Follow-up automatically provided by Health Authority.; Reported Cause(s) of Death: Exitus letalis/ patient is dead


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