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

This is VAERS ID 1208840



Case Details

VAERS ID: 1208840 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-01
Onset:2021-03-01
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 24
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEPFIZER INC2021398931

Write-up: contracts covid; contracts covid; This is a spontaneous report from a contactable consumer (Pfizer colleague). A 104-year-old female patient received first dose of bnt162b2 (COMIRNATY; Lot number was not reported) in Jan2021 and second dose (Lot number was not reported) in the beginning of Feb2021 both given via an unspecified route of administration, as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient contracted covid in the mid of Mar2021 with fatal outcome. The patient died on 26Mar2021 in the hospital. Cause of death was COVDI-19. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: covid; covid


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