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

This is VAERS ID 1107693



Case Details

VAERS ID: 1107693 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-23
Onset:2021-02-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0725 / UNK RA / -

Administered by: Other       Purchased by: ?
Symptoms: Multiple organ dysfunction syndrome
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 1
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: Arterial hypertension; Chronic atrial fibrillation; Cognitive deterioration; Renal impairment
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC2021250311

Write-up: Multiple organ failure; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB ES-AEMPS-766497. A 88-year-old female patient received bnt162b2 (COMIRNATY, lot number: EL0725), via an unspecified route of administration (on right arm) on 23Feb2021 at SINGLE DOSE for covid-19 immunisation. Medical history included renal impairment, arterial hypertension, chronic atrial fibrillation and advanced cognitive deterioration, all on unknown dates. Concomitant medications were not reported. It was reported that the patient died within 24 hours after administration of the vaccine. The reporter believed the cause was multi-organ failure on 23Feb2021. The patient died on 24Feb2021. An autopsy was not performed.; Reported Cause(s) of Death: Multiple organ failure


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