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

This is VAERS ID 1106074



Case Details

VAERS ID: 1106074 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-26
Onset:2021-02-28
   Days after vaccination:2
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
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 INC2021250865

Write-up: patient died; This is a spontaneous report from a contactable nurse . A 80-years-old male patient received bnt162b2 (COMIRNATY), via an on 26Feb2021 at single dose for covid-19 immunisation.Age at vaccination 80 years. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient died on 28Feb2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Sender''s Comments: Based on available information, a possible contributory role of the subject vaccine cannot be excluded for the reported even of death NOS due to temporal relationship. However, the reported event may possibly be associated with intercurrent medical conditions in this elderly patient. There is limited information provided in this report. Incomplete information does not permit a meaningful causality assessment. This case will be reassessed once additional information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Unknown cause of death


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