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

This is VAERS ID 1056153



Case Details

VAERS ID: 1056153 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-27
Onset:2021-02-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Blood culture, COVID-19, Chest X-ray, Multiple organ dysfunction syndrome, Pneumonia bacterial, Respiratory viral panel, SARS-CoV-2 test, Septic shock, Ultrasound chest, Vaccination failure, Viral test
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), 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), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EUTIROX; RETACRIT [EPOETIN ZETA]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic renal insufficiency (undergoing dialysis treatment); Closed fracture of multiple cervical vertebrae (C1-C2 fracture (September 2020) with atlantoaxial sub-dislocation and compression at bulb passage); Dialysis; Hypertension arterial; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Date: 20210210; Test Name: Blood culture; Result Unstructured Data: Test Result:positive for Acinetobacter Calcoaceticus-baumanni; Comments: positive for Acinetobacter Calcoaceticus-baumannii complex; Test Date: 20210210; Test Name: CXR; Result Unstructured Data: Test Result:complete opacification of the left hemithorax is d; Comments: complete opacification of the left hemithorax is documented as per lung atelectasis. Other more circumscribed parenchymal thickenings are noticeable on the right; Test Date: 20210210; Test Name: Respiratory viral panel; Result Unstructured Data: Test Result:positive for SARS-COV 2; Test Date: 20210211; Test Name: SARS-CoV-2 PCR test; Test Result: Positive ; Test Date: 20210210; Test Name: Lung ultrasound; Result Unstructured Data: Test Result:diffuse pattern of B lines bilaterally (left hemi; Comments: diffuse pattern of B lines bilaterally (left hemithorax greater than right hemithorax), presence of bilateral pleural sliding without macroscopic signs of pleural effusion; Test Date: 20210210; Test Name: rapid swab for Sars-Cov2; Test Result: Positive
CDC Split Type: ITPFIZER INC2021180724

Write-up: septic shock; multi-organ failure; SARS-CoV 2 infection; acute respiratory failure caused by untyped bacterial pneumonia; acute respiratory failure caused by untyped bacterial pneumonia; vaccination failure; This is a spontaneous report from a contactable physician downloaded from the regulatory authority manufacturer report number IT-MINISAL02-678359. A 63-year-old female patient received the second dose of BNT162B2 (Comirnaty, Lot No. EJ6797) intramuscularly on 27Jan2021, the first dose (Lot No. EL1484) was received on 05Jan2021, both at single dose for COVID-19 immunisation. Relevant history induced Type 2 diabetes mellitus, arterial hypertension, Chronic renal failure under dialysis treatment, closed fracture of multiple cervical vertebrae since 01Sep2020 (C1-C2 fracture (September 2020) with diver - atlanto-axial flux and compression at the bulb-medullary passage and on the cervical cord, without neurosurgical indication due to the high risk-benefit ratio. The patient had Long-term hospitalization. Relevant concomitant drug included levothyroxine sodium (EUTIROX) 50mcg tablet and epoetin zeta (RETACRIT) 4000 IU / 0.4 ML solution for injection for Chronic renal failure. Therapy administered in a nursing home included: Eutirox 50mcg, Humalog 6 UI for Diabetes mellitus, Lobivon 5 mg for Hypertension arterial, catapresan CRTT for Hypertension arterial, Nitrodem 10 mg, Calcium 1cpr, retacrit 4,000 for Chronic renal failure, Rocaltrol 0.25mcg, Omeprazen 20mg, Adalat crono 30 mg for Hypertension arterial, Lantus 12U.I for Diabetes mellitus. 15 days after the Covid-19 vaccination (II dose), the patient was found to have positive SARS-CoV 2 infection, and arrived in emergency room and then in Intensive T. on 10Feb2021 for acute respiratory failure caused by untyped bacterial pneumonia, died within 24 hours of septic shock and multi-organ failure (chest x-ray not suggestive of Covid pneumonia), with onset of respiratory symptoms on 05Feb2021 (reported by doctor). Treatment therapy included: Resuscitation treatment of the picture Respiratory, Hemodynamic and Renal (Invasive ventilation, amine-vasoactive, broad spectrum antibiotic therapy, CVVHDF dialysis treatment). Examinations performed on admission: Chest x-ray (on 10Feb2021): "complete opacification of the left hemithorax is documented as per lung atelectasis. Other more circumscribed parenchymal thickenings are noticeable on the right. ECHO-lung: diffuse pattern of B lines bilaterally (left hemithorax greater than right hemithorax), presence of bilateral pleural sliding without macroscopic signs of pleural effusion. Rapid swab positive for SARS CoV-2 performed by 118 crew (on 10Feb2021). Upper respiratory panel filmarray (nasopharyngeal swab) (on 10Feb2021): positive for SARS-COV 2. SARS CoV 2 PCR rt Positive (nasopharyngeal swab) (on 11Feb2021). FILMARRAY blood culture panel on 10Feb2021 positive for Acinetobacter Calcoaceticus-baumannii complex (on 10Feb2021, culture tests are in progress). FILMARRAY blood culture panel on 10Feb2021 positive for Acinetobacter Calcoaceticus-baumannii complex (on 10Feb2021, culture tests are in progress); complete opacification of the left hemithorax is documented as from pulmonary atelectasis. Other more circumscribed parenchymal thickenings are noticeable on the right; SUCCESSFUL; upper respiratory panel filmarray (nasopharyngeal swab) (10Feb2021): positive for SARS-COV 2; diffuse pattern of B lines bilaterally (left hemithorax greater than right hemithorax), presence of bilateral pleural sliding without macroscopic signs of pleural effusion.; Reported Cause(s) of Death: untyped bacterial pneumonia; acute respiratory failure; SARS-CoV 2 infection; vaccination failure; septic shock; multiorgan failure


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