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

This is VAERS ID 1213646

Case Details

VAERS ID: 1213646 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Death, General physical health deterioration, Vaccination site reaction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021389406

Write-up: Unknown cause of death; especially vaccination reaction; especially vaccination reaction; This is as spontaneous report received from a non-contactable physician downloaded from a regulatory authority-WEB. The regulatory authority report number is DE-PEI-PEI2021003966. A 97-year-old female patient received BNT162B2 (COMIRNATY; lot number and expiry date were not reported), intramuscular on Jan2021 (at the age of 97-years-old) at a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. It was reported that after vaccination, the patient developed "especially vaccination reaction" also reported as reduced general condition on 14Feb2021. Outcome of the events vaccination reaction and reduced general condition was unknown. The patient died on 14Feb2021. It was not reported if an autopsy was performed. Death cause was reported as unknown cause of death. The company assessment of the event with the drug was unclassifiable. No follow-up attempts are; information on lot and batch numbers cannot be obtained.; Reported Cause(s) of Death: Unknown cause of death

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