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

This is VAERS ID 1439289

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Case Details

VAERS ID: 1439289 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7338 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 0
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: Medical History/Concurrent Conditions: Neuralgia; Oedema
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC2021767364

Write-up: This is a spontaneous report from a contactable consumer received via COVID-19 Adverse Event Self-Reporting. The patient was a non-pregnant 81-year-old female. It was not reported whether the patient received any other vaccines within 4 weeks prior to the COVID vaccine or any other medications within 2 weeks of vaccination. It was unknown whether the patient was diagnosed with COVID-19 prior to vaccination. The patient had no allergies to medications, food, or other products. Other medical history included oedema and neuralgia. On 02Jun2021 at 10:30 (the day of vaccination), the patient received the first single dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number FA7338, Expiration date 30Sep2021) via an unspecified route of administration in the left arm for COVID-19 immunization. On 03Jun2021 (1 day after the vaccination), the patient experienced death. It was unknown if autopsy was done. The outcome of the event was fatal without treatment. It was unknown whether the patient the patient had been tested for COVID-19 since the vaccination.; Reported Cause(s) of Death: Death


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