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From the 10/8/2021 release of VAERS data:

This is VAERS ID 960173

Case Details

VAERS ID: 960173 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cardiac arrest, Cardiac failure congestive, Condition aggravated, General physical health deterioration, Myocardial ischaemia, Oxygen saturation, Oxygen saturation decreased, SARS-CoV-2 test
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ; ; ; ; ; ; COSMOCOL; ; ;
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Congestive cardiac failure; Constipation; Epilepsy; Frailty; Indigestion; Ischaemic heart disease; LVH; Pain; TIA
Diagnostic Lab Data: Test Date: 20201230; Test Name: o2 sats; Result Unstructured Data: Test Result:falling; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No
CDC Split Type: GBPFIZER INC2021024664

Write-up: Cause of death was unknown but was probably due to frailty/known IHD/CCF; Cause of death was unknown but was probably due to frailty/known IHD/CCF; Cause of death was unknown but was probably due to frailty/known IHD/CCF; Cause of death was unknown but was probably due to frailty/known IHD/CCF; General physical health deterioration; falling 02 sats; subsequent arrest; This is a spontaneous report from a contactable physician. This is a report received from the MHRA. Regulatory authority report number: GB-MHRA-WEBCOVID-20210112154920, and safety report unique identifier: GB-MHRA-ADR 24584672. A 90-year-old female patient received single dose of BNT162B2 (Solution for injection), via an unspecified route of administration on 29Dec2020 for COVID-19 immunization. Medical history included frailty of old age, congestive cardiac failure, atrial fibrillation (AF), left ventricular hypertrophy (LVH), transient ischaemic attack (TIA), ischaemic heart disease, epilepsy, indigestion, pain, and constipation. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Concomitant medication included apixaban from 31Oct2019 for persistent atrial fibrillation, atorvastatin from 10Sep2019 for ischaemic heart disease, bisoprolol from 05Dec2017 for ischaemic heart disease, carbamazepine from 21Jan2002 for epilepsy, cimetidine from 03Apr2020 for indigestion, codeine from 22May2015 for pain, macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (COSMOCOL) from 16Dec2019 for constipation, digoxin from 31Oct2019 for atrial fibrillation, furosemide from 05Mar2020 for heart failure, congestive; and perindopril from 11Jul2020 for heart failure, congestive. The patient experienced general physical health deterioration on 30Dec2020 next day after vaccination. Rapid deterioration in health: falling 02 sats and subsequent arrest. The events were considered serious: medically significant. Patient has not tested positive for COVID-19 since having the vaccine. The patient underwent lab tests and procedures which included COVID-19 virus test: no - negative covid-19 test on an unspecified date. The outcome of general physical health deterioration, falling O2 sats, and subsequent arrest was unknown.The patient died on 30Dec2020. Cause of death was unknown but was probably due to frailty/known IHD/CCF. Cannot say if vaccination was causer of this but patient died within 24 hrs of the vaccination. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Death

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