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

This is VAERS ID 1106071



Case Details

VAERS ID: 1106071 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-24
Onset:2021-02-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6790 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021256519

Write-up: Death; This is a spontaneous report received from a contactable physician via regulatory authority downloaded from the regulatory authority-WEB NL-LRB-00459988. An 88-year-old male patient received the second dose of BNT162B2 (COMIRNATY, lot number EJ6790), on 24Feb2021 at single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient previously took the first dose of BNT162B2 (COMIRNATY, lot number unknown), on 27Jan2021 at single dose for COVID-19 immunisation. It was reported that patient died on 28Feb2021. The event seriousness criteria was reported as death. It was not reported if an autopsy was performed and the reported cause of death was pre-existing co-morbidity. The outcome of the event was fatal. Reporter''s comments: There is no suspicion of a causal relationship between the corona vaccination and death, however, after telephone consultation with COVID line, it was decided to report it, as the death occurred relatively unexpectedly four days after the second corona vaccination was administered. Death is thought to have occurred as a result of pre-existing co-morbidity. No previous Covid-19 infection. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: There is no suspicion of a causal relationship between the corona vaccination and death, however, after telephone consultation with COVID line, it was decided to report it, as the death occurred relatively unexpectedly four days after the second corona vaccination was administered. Death is thought to have occurred as a result of pre-existing co-morbidity. No previous Covid-19 infection.; Reported Cause(s) of Death: pre-existing comorbidity


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