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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1336453

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Case Details

VAERS ID: 1336453 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-25
Onset:2021-05-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021553648

Write-up: Unknown cause of death; This is a spontaneous report received from a non- contactable physician downloaded from the Regulatory Authority (RA)-WEB, regulatory authority number is DE-PEI-202100063186. A72-year-old female patient received BNT162B2 (COMIRNATY) at 0.3 ml single dose via an unknown route on 25Apr2021 for COVID-19 immunisation. Medical history and concomitant medication were not reported. On 04May2021 the patient experienced unknown cause of death. Autopsy was performed and result was pending. Assessment: Source of assessment: Agency; Result of Assessment: D. Unclassifiable. Information about lot/batch number cannot be obtained. No further information expected.; Reported Cause(s) of Death: Unknown cause of death


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