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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1380467

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Case Details

VAERS ID: 1380467 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PEPFIZER INC2021630284

Write-up: COVID; This is a spontaneous report received from a contactable consumer or other non HCP. A 70-year-old female patient received bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported) via an unspecified route of administration on an unspecified date as unknown, single for for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient developed COVID six days after vaccination and died on the eighth day of illness (two days after being hospitalized). The patient died on an unspecified date. It was not reported if an autopsy was performed. The reported cause of death was COVID. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: COVID


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