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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1688720

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Case Details

VAERS ID: 1688720 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

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

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: Medical History/Concurrent Conditions: Raynaud''s syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type: BRPFIZER INC202101144750

Write-up: had a reaction and is hospitalized in serious condition / the patient had died; This is a spontaneous report from a contactable consumer received through COVAES portal (firstly by logistic colleague). A female patient of an unspecified age received first dose of bnt162b2 (COMIRNATY, Formulation: solution for injection, Lot number: unknown) via an unspecified route of administration on an unspecified date (age at the vaccination: 17-years-old) as DOSE 1, SINGLE for covid-19 immunisation. At the time of vaccination, pregnancy was reported as unknown. Medical history included raynaud''s phenomenon from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Other vaccine in four weeks was reported as unknown. Prior to the vaccination, the patient was not diagnosed with COVID-19. The reporter reported an adverse event that occurred in the school where she worked, a student took the 1st dose of the pfizer vaccine and she had a reaction and was hospitalized in serious condition in the hospital. The reporter informed that the patient had died on an unspecified date for an unspecified reason. Treatment AE was reported as unknown. It was unknown if any autopsy was performed.; Reported Cause(s) of Death: had a reaction and is hospitalized in serious condition / the patient had died


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