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

This is VAERS ID 1113848



Case Details

VAERS ID: 1113848 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-02-17
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   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 INC2021256593

Write-up: 2 weeks after vaccination dyspnoea; 2 weeks after vaccination fever; This is a spontaneous report from a contactable consumer received via the Regulatory Authority, downloaded from the Regulatory Authority-WEB. The regulatory authority report number is NL-LRB-00456375. An 85-year-old female patient received BNT162B2 (COMIRNATY, batch: unknown) via an unspecified route of administration on 29Jan2021 (unknown age at vaccination) at single dose for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient experienced 2 weeks after vaccination fever and 2 weeks after vaccination dyspnea, both on 17Feb2021. The patient died on 17Feb2021. The outcome of the events was fatal. It was unknown if an autopsy was performed. The reported cause of death was fever and dyspnea. No follow-up attempts are possible; information about batch/lot number cannot be obtained.; Reported Cause(s) of Death: fever; dyspnea


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1113848

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