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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1048221



Case Details

VAERS ID: 1048221 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-11
Onset:2021-01-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood lactic acid, Inflammatory marker test, Multiple organ dysfunction syndrome, Myocarditis, Septic shock
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-16
   Days after onset: 2
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: COVID-19 (not hospitalized)
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: Lactate values; Result Unstructured Data: Test Result:increased; Test Date: 202101; Test Name: Inflammation values; Result Unstructured Data: Test Result:increased
CDC Split Type: ATPFIZER INC2021164871

Write-up: Septic shock; extensive myo- and pericarditis; Multiple organ failure despite hemofiltration; This is a spontaneous report from a contactable pharmacist downloaded from the Agency Regulatory Authority-WEB AT-BASGAGES-2021-02122. An 81-year-old female patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on 11Jan2021 at single dose for covid-19 immunisation. Medical history included covid-19 not ongoing not hospitalized. The patient''s concomitant medications were not reported. The patient experienced septic shock, extensive myo- and pericarditis, multiple organ failure despite hemofiltration on 14Jan2021. The events were fatal. The patient underwent lab tests and procedures which included Lactate values and Inflammation values: increased in Jan2021. The patient died on 16Jan2021. An autopsy was performed that revealed carditis pericardium myocardium. Comirnaty/ all events/ Primary source/ Certain. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Septic shock; extensive myo- and pericarditis; Multiple organ failure despite hemofiltration; Autopsy-determined Cause(s) of Death: Carditis pericardium myocardium


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