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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1428702

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Case Details

VAERS ID: 1428702 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-04
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Fall, Femur fracture, General physical health deterioration, Investigation
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 12
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:
Preexisting Conditions: Medical History/Concurrent Conditions: Atherosclerosis; Heart failure NYHA class IV; Pertrochanteric fracture of femur, closed; Pneumonia bacterial
Allergies:
Diagnostic Lab Data: Test Date: 202105; Test Name: Examinations; Result Unstructured Data: Test Result:pertrochanteric fracture
CDC Split Type: HUPFIZER INC2021689192

Write-up: Death/poor general condition; fall; fall; This is a spontaneous report from a contactable physician downloaded from a regulatory authority HU-OGYI-394021 This spontaneous, serious, medically confirmed case was reported on 27May2021 by a physician and concerns the occurrence of death after COMIRNATY injection for active immunization to prevent COVID-19. On 04May2021 the 87-years-old female patient received the second dose of 0.3 ml BNT162B2 (COMIRNATY) concentrate for dispersion for injection (tozinameran (COVID-19 mRNA Vaccine embedded in lipid nanoparticles), batch number: unknown, expiry date: unknown, MAH: BioNTech Manufacturing GmbH/Pfizer) to prevent Covid-19. Medical history included NYHA class IV heart failure, bacterial pneumonia and atherosclerosis, pertrochanteric fracture of femur, closed. Concomitant drugs were not reported. The patient was hospitalized on 09May2021 after a fall. Examinations showed a pertrochanteric fracture which required surgery, but as the patient general condition was bad, she was unfit to have the surgery. Despite treatment, the patient passed away on 13May2021 at 06:10. Autopsy was performed. Further information is not expected. Sender Comment: As the patient was hospitalized because of a fall and then passed away due to her poor general condition, the causal relationship is unlikely between the suspected drug and the adverse event. The case is considered serious because the outcome was fatal. Further information is not expected. No follow-up attempts are possible, information on batch/lot number cannot be obtained.; Reported Cause(s) of Death: poor general condition


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