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

This is VAERS ID 1215381



Case Details

VAERS ID: 1215381 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-04-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3674 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dyspnoea, Malaise, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HALOPERIDOL; CLOPIDOGREL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiovascular disease, unspecified; COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210404; Test Name: Body temperature; Result Unstructured Data: Test Result:Fever: 38 to 40.5 degrees Celsius Centigrade; Test Date: 20201228; Test Name: SARS-CoV-2 test positive; Test Result: Positive
CDC Split Type: NLPFIZER INC2021399242

Write-up: Sudden breathlessness, followed by death; not feeling well/malaise; Fever: 38 to 40.5 degrees Celsius; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB regulatory authority NL-LRB-00497586. A 75-years-old female patient received BNT162B2 (COMIRNATY), first dose via an unspecified route of administration on 01Apr2021 (Lot Number: ET3674) as single dose for COVID-19 immunisation. Medical history included COVID-19 from 28Dec2020 without disease symptoms and cardiovascular disease. Concomitant medication(s) included haloperidol and clopidogrel. On 04Apr2021, the patient experienced sudden shortness of breath and not feeling well/malaise, after which death. Adverse event came about suddenly. The patient also experienced fever: 38 to 40.5 degrees Celsius on 04Apr2021. There were no diagnostic procedures. The patient underwent SARS-COV-2 test positive on 28Dec2020. The patient died on an unspecified date. It was not reported if an autopsy was performed. The event outcome for events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden breathlessness, followed by death; Malaise; Fever: 38 to 40.5 degrees Celsius


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