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From the 5/7/2021 release of VAERS data:

This is VAERS ID 850493



Case Details

VAERS ID: 850493 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Foreign  
Vaccinated:2019-11-06
Onset:2019-11-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2019-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (FLUAD) / NOVARTIS VACCINES AND DIAGNOSTICS 259146C11 / UNK - / OT
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. S008678 / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-11-08
   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: COPD; Dementia; Heart disease, unspecified
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITSEQIRUS201906361

Write-up: Temporal correlation between influenza and pneumococcal vaccination and death; This is a spontaneous case, initially reported by physician and initially retrieved from Regulatory Authority (Authority Number: IT-MINISAL02-589091) on 28-Nov-2019, concerning a 94-year-old, female patient. The patient''s current conditions included COPD (chronic obstructive pulmonary disease) with frequent exacerbations, heart disease in feeble compensation and dementia decompensated. The patient''s concomitant medication was not reported. On 06-Nov-2019, the patient was administered Fluad [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59; route of administration: intramuscular, batch number: 259146C11, dose, anatomical location and expiry date: not reported] for H1N1 influenza immunisation. On the same date, the patient was administered co-suspect vaccine Pneumovax [pneumococcal vaccine polysacch 23v; batch number: S008678, dose, route of administration, anatomical location and expiry date: not reported] for an unknown indication. On 08-Nov-2019, two days after vaccination, the patient died. It was unknown whether autopsy was performed. The outcome of the event was fatal. The reporter considered the event of death as temporarily related to vaccination, but did not suppose a causal correlation given the precariousness of the pre-existing clinical picture in (high age) elderly patient. The event was assessed as serious due to the criterion of death and medically significant. Company causality: The event was considered as related to Fluad (TIV).; Reporter''s Comments: Reporter''s comment: I report for the temporal correlation, but I do not suppose a causal correlation given the precariousness of the pre-existing clinical picture in (high age) elderly patient.; Sender''s Comments: The event was considered as related to Fluad (TIV).; Reported Cause(s) of Death: Unknown cause of death


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