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

This is VAERS ID 1210316



Case Details

VAERS ID: 1210316 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-04
Onset:2021-03-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary embolism, Venous thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: THYROXIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIPFIZER INC2021389403

Write-up: Pulmonary embolism; Venous thrombosis; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority. Regulatory authority number FI-FIMEA-20211617. This is a spontaneous report from a contactable consumer or other non hcp downloaded from the regulatory authority, regulatory authority number FI-FIMEA-20211617. A 80-years-old female patient received the first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 04Mar2021 (at the age of 80) (Batch/Lot Number: UNKNOWN) as single dose for covid-19 immunisation. Medical history included hypothyroidism. Concomitant medication included levothyroxine sodium (THYROXIN) taken for hypothyroidism. Five days after taking the vaccine, on 09Mar2021, the patient was found dead at home. The patient experienced pulmonary embolism on 04Mar2021, venous thrombosis on 04Mar2021. The cause of death was determined in a forensic autopsy, and the cause of death was venous thrombosis and pulmonary embolism. Information about lot/batch number cannot be obtained. No further information expected.; Autopsy-determined Cause(s) of Death: Pulmonary embolism; Venous thrombosis


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