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

This is VAERS ID 1165305



Case Details

VAERS ID: 1165305 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-17
Onset:2021-03-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3620 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Medical History/Concurrent Conditions: Aortic stenosis; Arthrosis; Decompensation cardiac; Dementia NOS; Hypertension arterial; Senile macular degeneration
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021342463

Write-up: Asthenia; Epigastric pain; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB FR-AFSSAPS-RE20210850. A 90-year-old female patient received bnt162b2 (COMIRNATY, lot number ET3620 and expiration date not provided), intramuscular, administered in Arm Right first dose on 17Mar2021 at single dose for Covid-19 immunization. The patient''s medical history included Hypertension arterial, Dementia NOS, Senile macular degeneration, Arthrosis, Aortic stenosis, and Decompensation cardiac. The patient''s concomitant medications were not reported. On 17Mar2021, twelve hours after injection the patient presented epigastric pain and asthenia. The patient died 2 hours after the onset of symptoms (without further details). It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Asthenia; Epigastric pain


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