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

This is VAERS ID 1178308



Case Details

VAERS ID: 1178308 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Washington  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: USPFIZER INC2021371687

Write-up: two deaths in her state from vaccine; This is a spontaneous report received from a contactable consumer. This consumer reported similar events for two patients. This the first of two reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number not provided), on unspecified date at single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. Reporter was concerned because there had been two deaths in her state from vaccine and thought Pfizer might be curious in how their product was being handled. The patient died on unspecified date. It was unknown if autopsy was performed. The outcome of the event was fatal. Information on lot/batch number has been requested.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-2021371688 same reporter/event, different patient; Reported Cause(s) of Death: two deaths in her state from vaccine


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