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

This is VAERS ID 1065047



Case Details

VAERS ID: 1065047 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-02-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6134 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Culture, Malaise, Muscle spasms, Urinary tract infection
SMQs:, Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CIPROFLOXACIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Malaise (before vaccination)
Allergies:
Diagnostic Lab Data: Test Date: 20210122; Test Name: culture; Result Unstructured Data: Test Result:urinary tract infection
CDC Split Type: NLPFIZER INC2021191184

Write-up: general malaise since 22-1 2x antibiotic for urinary tract infection (based on culture), kink 1-2; general malaise since 22-1 2x antibiotic for urinary tract infection (based on culture), kink 1-2; general malaise since 22-1 2x antibiotic for urinary tract infection (based on culture), kink 1-2; This is a spontaneous report from a contactable physician downloaded from the regulatory authority NL-LRB-00443431. A 91-year-old female patient received the 1st dose of bnt162b2 (COMIRNATY, Lot # EJ6134) on 29Jan2021 at single dose for covid-19 immunisation. The patient medical history malaise. No previous COVID-19 infection. Concomitant medication included ciprofloxacin (CIPROFLOXACIN tablet 500mg) for urinary tract infection. On 01Feb2021, 3 days after vaccination, the patient experienced general malaise since 22-1 2x antibiotic for urinary tract infection (UTI) (based on culture), kink 1-2 (as reported). Patient already had malaise before vaccination. The outcome of malaise was fatal. The patient died on an unspecified date in 2021. It was not reported if an autopsy was performed. Reporters comments: BioNTech / Pfizer vaccine (Comirnaty). Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): no. General malaise from 22-1 2x AB for UTI (based on culture), kink 1-2. Additional information ADR: patient eventually died. COVID19 - Previous COVID-19 infection: No. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty) Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): no malaise from 22-1 2x AB for UTI (based on culture), kink 1-2 Additional information ADR: patient eventually died COVID19 - Previous COVID-19 infection: No; Reported Cause(s) of Death: general malaise; urinary tract infection (UTI)


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