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

This is VAERS ID 1114007



Case Details

VAERS ID: 1114007 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-01-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 2
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: DEPFIZER INC2021266968

Write-up: Unknown cause of death; Route of administration: Intravenous; This is a spontaneous report from a non-contactable consumer downloaded from the Regulatory Authority with regulatory authority number DE-PEI-CADR2021014956. A 78-year-old female patient received BNT162B2 (COMIRNATY, lot number unknown), intravenous on 29Jan2021 at age of 78-year-old at single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced unknown cause of death on 31Jan2021. An autopsy was not performed. Sender Comment: my mother was in a nursing home and initially, she had refused her consent to the Corona vaccination. Since not all side effects were listed in the consent form, she was presented a new form for signature at a later date. How they wheedled consent from her, my mother can no longer tell us because she has died 48 hours after the vaccination. Friday she got the vaccination. Saturday she was brought with the emergency ambulance to the hospital and then died the following night. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1114007

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