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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1319053

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Case Details

VAERS ID: 1319053 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-09
Onset:2021-02-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL7834 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Malaise, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 60
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021400534

Write-up: the clot she developed has brought about her passing this morning; unwell; This is a spontaneous report from a contactable consumer or other non hcp. A 67-year-old female patient received first dose bnt162b2 (BNT162B2, Formulation: solution for injection, Batch/Lot Number: EL7834; Expiration Date: not provided), via intramuscular, administered in arm on 09Feb2021 as SINGLE DOSE for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 12Feb2021, 3 days after vaccine the patient began to feel unwell, diagnosed clot and sent to hospital. After several days on ward with oxygen no improvement so transferred into critical care. After all attempts nothing could be done. The patient was hospitalized for 10 days. Therapeutic measures were taken prescribed two courses of Antibiotics over phone by GP, deteriorated during and after the two courses. As a result of the clot she developed has brought about her passing this morning, unwell. The patient died on 14Apr2021. An autopsy was not performed. The reported cause of death was the clot she developed has brought about her passing this morning. The outcome of event was fatal and not recovered/not resolved.; Reported Cause(s) of Death: the clot she developed has brought about her passing this morning


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