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From the 5/7/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 1000251

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Case Details

VAERS ID: 1000251 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-13
Onset:2021-01-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure, Cardiovascular disorder, Death, General physical health deterioration, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   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: LIXIANA; BURINEX; ESCITALOPRAM; AMLOR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension; Osteoporosis; Comments: Hypertension, Osteoporosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEPFIZER INC2021088938

Write-up: General physical health deterioration; Cardiac failure; Lung edema; Cardiovascular disorder; This is a spontaneous report downloaded from the Medicines Agency (MA) WEB BE-FAMHP-DHH-N2021-75687. A contactable physician reported that a 85 years old female patient received first dose BNT162B2 (COMIRNATY), via an unspecified route of administration on 13Jan2021 at single dose for COVID-19 vaccination. The medical history included hypertension, osteoporosis. Concomitant drugs were escitalopram (strength 10 mg), bumetanide (BURINEX, strength 1 mg), edoxaban tosilate (LIXIANA, strength 60 mg) and amlodipine besilate(AMLOR, strength 10 mg).On 20Jan2021 the patient suffered from cardiovascular disorder, lung edema, cardiac failure and general physical health deterioration during treatment with BNT162B2. The patient died on 20Jan2021. It''s unknown if an autopsy was performed. The cause of death was cardiovascular disorder, lung edema, cardiac failure and general physical health deterioration. The outcome of events was fatal. Reporter Comment: no really obvious side effects after vaccination. earlier further deterioration (so this already deteriorated before vaccination) No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: no really obvious side effects after vaccination. earlier further deterioration (so this already deteriorated before vaccination); Reported Cause(s) of Death: General physical health deterioration; Cardiac failure; Lung edema; Cardiovascular disorder


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