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

This is VAERS ID 1209281



Case Details

VAERS ID: 1209281 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021389879

Write-up: died 4 days after vaccination, external signs appeared to resemble an asthma attack/ breathless after gasping for breath; This is a spontaneous report from a contactable consumer (patient''s relative) based on information received by Pfizer from Biontech (manufacturer control number 33034), license party for Comirnaty. A 67-year-old patient of unspecified gender received BNT162B2 (COMIRNATY, lot number not provided), on unspecified date at single dose for COVID-19 immunisation. The patient''s medical history included ongoing asthma. The patient''s concomitant medications were not reported. It was reported that the week of the present report (Apr2021) a relative of reporter (patient) with asthma died 4 days after COVID-19 vaccination by Biontech/Pfizer vaccine. The exact cause of death was unclear until autopsy was done, but external signs appeared to resemble an asthma attack. The person became breathless after gasping for breath and he/she could not be resuscitated. The patient died on unspecified date in Apr2021. It was unknown if autopsy was performed. The outcome of the event was fatal. Information about lot/batch number has been requested.; Reported Cause(s) of Death: died 4 days after vaccination, external signs appeared to resemble an asthma attack/ breathless after gasping for breath


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