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

This is VAERS ID 1045034

Case Details

VAERS ID: 1045034 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Diarrhoea, Heart rate, Hypotension, Malaise, Oxygen saturation, Oxygen saturation decreased, Respiratory depression, SARS-CoV-2 test, Septic shock, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Toxic-septic shock conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 2
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: Dementia Alzheimer''s type; Hip prosthesis insertion (Total right hip replacement); Hypothyroidism
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (right breast neoplasia); Depression
Diagnostic Lab Data: Test Date: 20210204; Test Name: Blood pressure; Result Unstructured Data: Test Result:115 / 77 mmHg; Test Date: 20210204; Test Name: heart rate; Result Unstructured Data: Test Result:110 / minute; Test Date: 20210204; Test Name: desaturation; Test Result: 80 %; Comments: 80 percent desaturation; Test Date: 20210204; Test Name: desaturation; Result Unstructured Data: Test Result:91-92 %; Comments: a rise in saturation to 91-92 percent; Test Date: 20210205; Test Name: Covid-19 virus test; Test Result: Negative
CDC Split Type: FRPFIZER INC2021159199

Write-up: septic shock; acute respiratory depression; Hypotension; Oxygen saturation decreased; Feeling sick; Diarrhea; Tachycardia; This is a spontaneous report from a contactable Physician downloaded from the Medicines Agency (MA) Regulatory authority-WEB FR-AFSSAPS-TO20210407. This is a report received from the Regulatory Authority. A 92-year-old female patient received her first dose of bnt162b2 (COMIRNATY, lot number EJ6788), intramuscularly on right arm on 04Feb2021 at single dose for COVID-19 vaccination. Medical history included breast cancer (right breast neoplasia), ongoing dementia alzheimer''s type, ongoing hip prosthesis insertion (Total right hip replacement), ongoing hypothyroidism, depression from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced hypotension, oxygen saturation decreased, feeling sick, diarrhea and tachycardia on 04Feb2021. Serious criteria reported as death and hospitalization for events. Faint-like discomfort with profuse diarrhea, grayish face complexion, regular tachycardia 110 / minute, 80 percent desaturation. Placed in decubitus raised legs with emergency O2 put on (3 liters / minute with nasal glasses to obtain a rise in saturation to 91-92 percent). Follow-up 30 minutes after: blood pressure 115 / 77mm Hg, Regular heartbeats 85 bpm, Stay on watch. Suspicion of Covid-19 infection negative on 05Feb2021. Hospitalized for septic shock on 06Feb2021 at a urinary call point in a context of acute respiratory depression. Implementation of antibiotic therapy with Rocephin on 06Feb2021. The patient died on 06Feb2021. It was unknown if an autopsy was performed. No follow-up attempts possible. No further information expected. Information on lot and batch numbers already obtained.; Reported Cause(s) of Death: Hypotension; Oxygen saturation decreased; Feeling sick; Diarrhea; Tachycardia; septic shock; acute respiratory depression; Respiration failure

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