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

This is VAERS ID 1213645



Case Details

VAERS ID: 1213645 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-01-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, General physical health deterioration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021389408

Write-up: Unknown cause of death; increasing deterioration; This is a spontaneous report from a non-contactable physician downloaded from a regulatory authority-WEB, regulatory authority number DE-PEI-PEI2021003965. A 95-year-old female patient received first dose bnt162b2 (COMIRNATY; Lot Number: not reported) intramuscular, on Jan2021, as SINGLE DOSE for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 30Jan2021, after vaccination, the patient developed Reduced general condition and Unknown cause of death. The patient died on 30Jan2021. The events were considered as serious (medically significant). Outcome of Reduced general condition was fatal. Causes of death was reported as unknown cause of death and Reduced general condition. It was unknown if an autopsy was performed. No follow-up attempts are possible, information on batch/lot number cannot be obtained.; Reported Cause(s) of Death: Unknown cause of death; Reduced general condition


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