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

This is VAERS ID 1339145

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Case Details

VAERS ID: 1339145 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Arteriosclerosis, Cachexia, Dementia, SARS-CoV-2 test
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 13
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: Alzheimer''s disease; Bipolar affective disorder; Hypertension; Osteoporosis; Parkinson''s disease
Preexisting Conditions:
Diagnostic Lab Data: Test Name: COVID-19 PCR test; Test Result: Negative
CDC Split Type: HUPFIZER INC2021560195

Write-up: cachexia; Dementia NOS; General atherosclerosis; This is a spontaneous report from a contactable physician downloaded from a regulatory authority WEB HU-OGYI-287021. A 70-year-old female patient received bnt162b2 (COMIRNATY), dose 2 intramuscular, administered in Arm Left on 06Apr2021 (Batch/Lot Number: EW2239) as 2nd dose, 0.3ml single for covid-19 immunisation. Medical history included ongoing Alzheimer''s disease, ongoing osteoporosis, ongoing hypertension, ongoing Parkinson''s disease, ongoing Bipolar affective disorder. Historical vaccine included the first dose of 0.3 ml bnt162b2 (batch number: EJ6790, expiry date unknown, intramuscularly, in left arm) for COVID-19 immunisation. The patient''s concomitant medications were not reported. On 14Apr2021, the patient died. According to the patient s death certificate, the direct cause of death was cachexia (on 14Apr2021), indirect causes were dementia NOS (in Apr2021) and general atherosclerosis (in Apr2021). The autopsy was not performed. Other information the patient was under in-patient care at the time of the vaccinations, the hospitalization started on 21Dec2020 (reported as 21Dec2021). The COVID-19 PCR test was negative. The outcome of events was fatal. In the reporter physician s opinion, the patient s death is related to her underlying diseases. Sender''s comments: The 70 year old patient died 8 days after Comirnaty vaccination. The cause of death was cachexia. The causal relationship between the reported death and the vaccine is considered unlikely. The case is serious due to fatal outcome. No follow up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Dementia NOS; General atherosclerosis; cachexia

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