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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1318086

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Case Details

VAERS ID: 1318086 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Death

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: Alzheimer''s disease; Diabetes
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CRPFIZER INC2021517047

Write-up: Passed away/died; This is a spontaneous report from a non-contactable consumer. A 84-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date as single dose, for covid-19 immunisation. Medical history included ongoing alzheimer''s and ongoing diabetes. The patient''s concomitant medications were not reported. The patient previously received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecified date for COVID-19 Immunization. The consumer reported that his grandmother (the patient), an 84-year-old female patient, with a pathological history of Alzheimer''s and Diabetes, died a week after the placement of the second dose of the Pfizer Covid 19 vaccine. The consumer stated that both Alzheimer''s and Diabetes were under control at the time of vaccination, and that the death of the patient surprised them. She was "healthy", she went to sleep, and the next day, she woke up dead, a week after receiving the vaccine (second dose). The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow up attempts are possible; Information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Passed away/died

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