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

This is VAERS ID 1269775



Case Details

VAERS ID: 1269775 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-29
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 INC2021465549

Write-up: dies hours after getting Covid-19 vaccine; This is a spontaneous report from a non-contactable consumer (Pfizer-sponsored program). A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; Solution for injection; Lot Number: Unknown), via an unspecified route of administration on an unspecified date as SINGLE DOSE for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced dies hours after getting covid-19 vaccine on an unspecified date. It was not reported if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are Possible; information about batch/ lot number cannot be obtained.; Reported Cause(s) of Death: dies hours after getting Covid-19 vaccine


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