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

This is VAERS ID 1225026



Case Details

VAERS ID: 1225026 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-22
Onset:2021-02-12
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   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 INC2021398833

Write-up: Unknown cause of death; This is a spontaneous report from a non-contactable physician downloaded from a regulatory authority -WEB, regulatory authority number DE-PEI-202100032181. A 90-year-old female patient received bnt162b2 (COMIRNATY) via an unspecified route of administration on 22Jan2021 (Lot number was not reported) as 0.3 mL, single for covid-19 immunization at age 90 years old. The patient''s medical history and concomitant medications were not reported. The patient previously received the first dose of COMIRNATY on 31Dec2020 as 0.3 mL, single for COVID-19 immunization at age 90 years old The patient experienced unknown cause of death on 12Feb2021. The patient died on 12Feb2021. An autopsy was not performed. The relatedness of Comirnaty to death was unclassifiable as per PEI. No follow-up attempts are possible. No further information is expected. Batch/lot number cannot be obtained.; Reported Cause(s) of Death: Unknown cause of death


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