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

This is VAERS ID 1038993



Case Details

VAERS ID: 1038993 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-26
Onset:2021-02-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Altered state of consciousness, Dehydration, Depressed level of consciousness, Diarrhoea, Dyspnoea, Erythema, Haematochezia, Respiratory distress, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Medical History/Concurrent Conditions: Atrial fibrillation; Behavior disorder; COVID-19; CVA (Sylvian left stroke and post stroke comitiality); Disorder personality; Hypertension; Non-insulin-dependent diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021151655

Write-up: Respiratory distress; Obtundation; Erythema; Emesis; Dehydration; mucous diarrhea appeared with traces of blood/diarrhea; mucous diarrhea appeared with traces of blood/diarrhea; Dyspnoea; disturbance of consciousness; This is a spontaneous report from a contactable Physician downloaded from the Medicines Agency (MA) -WEB with Regulatory authority report number FR-AFSSAPS-TO20210399. A 90-year-old female patient received first dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number: EJ6788), intramuscularly on 26Jan2021 at single dose in right arm for COVID-19 vaccination. Medical history included COVID-19 from an unknown date and not ongoing; Cerebrovascular accident (CVA, Sylvian left stroke and post stroke comitiality) from an unknown date and unknown if ongoing, Hypertension from an unknown date and unknown if ongoing, Atrial fibrillation from an unknown date and unknown if ongoing; Non-insulin-dependent diabetes mellitus from an unknown date and unknown if ongoing; Behavioral and personality disorders from an unknown date and unknown if ongoing. The patient''s concomitant medication included anticoagulant for Atrial Fibrillation. The patient experienced respiratory distress, obtundation, erythema, emesis, dehydration, diarrhoea, all on 03Feb2021. On the morning of 03Feb2021, mucous diarrhea appeared with traces of blood. Then very profuse vomiting (several liters) and repeated very quickly evolving into dehydration. Then respiratory distress without hindrance. Dyspnoea and significant desaturation poorly compensated (72 percent to 80 percent) by O2 therapy at 8L/minute. Finally, disturbance of consciousness with opposition to treatment. Then death. After the death an erythema extended to the level of the upper right limb was noted. The patient died on 03Feb2021. It was not reported if an autopsy was performed. The outcome of events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: mucous diarrhea appeared with traces of blood; Dyspnoea; disturbance of consciousness; Respiratory distress; Obtundation; Erythema; Vomiting; Dehydration; Diarrhoea


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