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

This is VAERS ID 1425718

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Case Details

VAERS ID: 1425718 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-26
Onset:2021-06-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY4835 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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: PHPFIZER INC2021717058

Write-up: Unconscious; This is a spontaneous report from a contactable physician. This is a report received from the Regulatory Authority. Regulatory authority report number PH-PHFDA-300083596. A 58-years-old female patient received BNT162B2 (COMIRNATY, Solution for injection), intramuscular on 26May2021 (Lot Number: EY4835) as dose number unknown, single (at age of 58-years-old) for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced unconscious (death, medically significant) on 03Jun2021 07:30. The patient died on an unspecified date. It was not reported if an autopsy was performed. Outcome of the event was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Unconscious


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