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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1038989



Case Details

VAERS ID: 1038989 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-21
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Aerococcus urinae infection, Body temperature, Death, Hyperthermia, Pyrexia, Urological examination, Urosepsis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 29
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: Medical History/Concurrent Conditions: Cerebral amyloid angiopathy; Hypertension arterial; NIDDM
Allergies:
Diagnostic Lab Data: Test Date: 20210124; Test Name: body temperature; Result Unstructured Data: Test Result:38 degrees; Test Date: 20210128; Test Name: cytobacteriological examination of the urine; Result Unstructured Data: Test Result:positive for Aerococcus Urinae
CDC Split Type: FRPFIZER INC2021151099

Write-up: Death unexplained; Aerococcus Urinae in urine; Fever (38 degrees); hyperthermia; possible context of sepsis with urinary origin; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) -WEB (FR-AFSSAPS-RS20210133). A 93-year-old female patient received the first dose of BNT162B2 (COMIRNATY; Lot number: EJ6788), intramuscularly in the left arm, on 21Jan2021 at a single dose for SARS-CoV-2 vaccination. Medical history included hypertension arterial, non-insulin-dependent diabetes mellitus (NIDDM), and cerebral amyloid angiopathy. The patient was not previously diagnosed with COVID-19. The patient''s concomitant medications were not reported. The patient experienced fever (38 degrees) on 24Jan2021 and death unexplained on 30Jan2021, which were reported as fatal. The patient also experienced hyperthermia on 24Jan2021, Aerococcus Urinae in urine on 28Jan2021, and possible context of sepsis with urinary origin in Jan2021. The clinical course was reported as follows: The patient had an onset of fever (body temperature of 38 degrees on 24Jan2021) and hyperthermia. On 26Jan2021, there was alteration of the general condition and the patient therefore remained in bed. On 28Jan2021, the cytobacteriological examination of the urine collected was positive for Aerococcus Urinae; hence, the patient was treated with ceftriaxone sodium (ROCEPHIN). On 30Jan2021, the patient was found dead (as reported: it is concluded that she died in a possible context of sepsis with urinary origin). Therapeutic measures were taken as a result of fever (38 degrees), hyperthermia, Aerococcus Urinae in urine, and possible context of sepsis with urinary origin, which included unspecified antipyretics and ceftriaxone sodium as aforementioned. The patient died on 30Jan2021. The cause of death was assessed as possible context of sepsis with urinary origin (reported as death unexplained). It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: possible context of sepsis with urinary origin


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