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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1152835



Case Details

VAERS ID: 1152835 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-21
Onset:2021-02-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4243 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Arterial thrombosis, Malaise, SARS-CoV-2 test, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SIMVASTATIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data: Test Date: 20210205; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021306489

Write-up: Felt unwell; a large blood clot was discovered in the artery to the bowel; Death sudden; This is a spontaneous report from a contactable consumer. This is a report received from the Agency Regulatory Authority (RA). Regulatory authority report number: GB-MHRA-WEBCOVID-202103201901276170, Safety Report Unique Identifier: GB-MHRA-ADR 24986407. A 90-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number: EK4243, expiration date: unknown), via an unspecified route of administration on 21Jan2021 (at the age of 90 years old) at a single dose for COVID-19 immunisation. Medical history included blood pressure high. Concomitant medication included simvastatin. The patient has not had symptoms associated with COVID-19 and was not enrolled in clinical trial. It was reported that the patient felt unwell on unspecified date immediately after the COVID vaccine. The patient continued to feel unwell and a large blood clot was discovered in the artery to the bowel and was admitted to hospital on Thursday, 04Feb2021. It was further reported that the patient deteriorated and died (sudden death) on 21Feb2021 (also reported as 10Feb2021). The patient underwent lab tests and procedures which included COVID-19 virus test: no - negative COVID-19 test on 05Feb2021. Since the vaccination, the patient had not tested positive for COVID-19. Outcome of the events felt unwell and a large blood clot was discovered in the artery to the bowel was unknown. The patient died on 21Feb2021. It was unknown whether an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death sudden


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