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

This is VAERS ID 1056230



Case Details

VAERS ID: 1056230 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-12
Onset:2021-02-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Heart rate, Laboratory test, Liver function test, Multiple organ dysfunction syndrome, Oxygen saturation, Renal function test
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 (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 1
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: body temperature; Result Unstructured Data: Test Result:no fever; Test Name: Heart rate; Result Unstructured Data: Test Result:sinus rhythm; Test Name: infection parameters; Result Unstructured Data: Test Result:increased infection parameters; Test Name: Laboratory test; Result Unstructured Data: Test Result:no infiltration; Test Name: liver function test; Result Unstructured Data: Test Result:liver failure; Test Name: O2 saturation; Test Result: 92 %; Test Name: kidney function test; Result Unstructured Data: Test Result:kidney failure
CDC Split Type: DEPFIZER INC2021191549

Write-up: Multiorgan failure; This is a spontaneous report from physician downloaded from the regulatory authority-WEB DE-PEI-PEI2021002719 and received via Regulatory Authority. An 89-year-old female patient received the second dose bnt162b2 (COMIRNATY) (Lot no. was not reported), via an unspecified route of administration at single dose on 12Feb2021 for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Previously the patient received the first dose of Comirnaty on an unspecified date for covid-19 immunisation. On 16Feb2021, the patient developed multiorgan failure. The patient was hospitalized and condition was life threatening. The patient died on 17Feb2021. It was not reported if an autopsy was performed. Death cause was reported as multiorgan failure. The patient underwent lab tests and procedures which included on an unspecified date body temperature: no fever; heart rate: sinus rhythm; laboratory test: increased infection parameters; laboratory test: no infiltration; liver function test: liver failure; oxygen saturation: 92 %; renal function test: kidney failure. Reporter''s comments: In the laboratory: liver and kidney failure, increased infection parameters, no fever, no inflation rate, sinus rhythm. No follow-up attempts are possible. No further information expected; Information about batch/lot number cannot be obtained.; Reporter''s Comments: In the laboratory: liver and kidney failure, increased infection parameters, no fever, no inflation rate, sinus rhythm; Reported Cause(s) of Death: Multiorgan failure


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