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

This is VAERS ID 1227287



Case Details

VAERS ID: 1227287 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021416943

Write-up: within two weeks of receiving the vaccine both family members died; This is a spontaneous report based on information received by Pfizer (Case Number: 01903495). A contactable Consumer reported for two family members. A male patient of an unspecified age received bnt162b2 (BNT162B2), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation . The patient medical history and concomitant medications were not reported. The patient died on an unspecified date within two weeks of receiving the vaccine . It was not reported if an autopsy was performed. No follow-up attempts are possible, information about lot/batch number cannot been obtained.; Reported Cause(s) of Death: Unknown cause of death


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