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

This is VAERS ID 1106072



Case Details

VAERS ID: 1106072 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-24
Onset:2021-02-25
   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 - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   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: SINEMET; OMEPRAZOL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021256570

Write-up: Death; Malaise; This is a spontaneous report from a contactable other healthcare professional via Regulatory Authority, downloaded from the Agency Regulatory Authority-WEB (NL-LRB-00463055). A 92-year-old female patient received BNT162B2 (COMIRNATY) via an unspecified route of administration on 24Feb2021 at single dose for COVID-19 immunisation. Relevant medical history was not reported. Concomitant medications included carbidopa/levodopa (SINEMET) 100mg/25mg and omeprazole (OMEPRAZOL) 20 mg. On 25Feb2021, the patient experienced malaise and died on the same date. The cause of death was unknown. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot and or batch number cannot be obtained.; Reported Cause(s) of Death: death


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