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

This is VAERS ID 1065048



Case Details

VAERS ID: 1065048 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-01-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cachexia, Depressed level of consciousness, Fatigue, Malaise
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PARACETAMOL; ESOMEPRAZOLE; FENTANYL
Current Illness: Reduced general condition (before vaccination)
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease; Cognitive disorder; Diabetes mellitus; Fractured sacrum; Gonarthrosis; Hypertension; Incontinence of urine (due to cognitive problem); Infection (antibiotic); Osteoporosis; Phacoemulsification (OD2007); Pneumonia; Prosthesis fracture (Status after left neck prosthesis due to fracture); Scabies; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021199233

Write-up: cachexia; partly conscious; Not feeling well; Fatigue; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) regulatory authority-WEB NL-LRB-00444118, Safety Report Unique Identifier NL-LRB-00445742. An 89 years old female patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, lot number: EM0477), via an unspecified route of administration on 29Jan2021 at single dose (1 dose form) for COVID-19 immunisation. Medical history included Hypertension, Osteoporosis, Diabetes mellitus from 2015, Gonarthrosis from 2012, Alzheimer''s disease, Pneumonia from 2014, Infection toe wv antibiotic from 2011, Scabies from 2010, phacoemulsification from 2007 (reported as "OD2007"), sacrum fracture in osteoprorosis from 2003, Status after left neck prosthesis due to fracture from 1992, Type 2 diabetes mellitus (DM2) from 1990, Incontinence of urine due to cognitive problem, health was already declining before vaccination and ongoing. Concomitant medications included paracetamol, esomeprazole, fentanyl patch. On 31Jan2021, the patient experienced not feeling well (death), fatigue (death) following administration bnt162b2 for covid 19 immunisation. Physician described that the patient''s health was already declining before vaccination and that there was doubt if the patient should be vaccinated. Her health declining was predominantly caused by her stopping to eat and drink. Drugs and latency for bnt162b2 and malaise/ fatigue was 2 days after start. It was reported that follow-up on 16Feb2021, the patient died on 13Feb2021 due to cachexia when stopping drinking, partly conscious. The patient was already vulnerable, admitted to a nursing institution for psychogeriatric patients, there were still doubted as to whether she should be vaccinated, eventually she died after consultation. The decline was mainly indicated in the context of the decline in stopping eating and drinking. Events not feeling well, fatigue and cachexia Resulted in death. No corona test was taken. No autopsy was performed. The outcome of the event partly conscious was unknown, of the events was fatal. Case Summary and Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty) Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): no confounding factors confounding factors: Alzheimer''s dementia COVID19 Previous COVID-19 infection: No; Other diagnostic procedures: no comments to report form: Already worsening with doubts about whether she should be vaccinated. Would say she died in deterioration with the corona vaccination rather than that she died as a result of the vaccination. 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 confounding factors confounding factors: Alzheimer''s dementia COVID19 Previous COVID-19 infection: No; Other diagnostic procedures: no comments to report form: Already worsening with doubts about whether she should be vaccinated. Would say she died in deterioration with the corona vaccination rather than that she died as a result of the vaccination. ; Reported Cause(s) of Death: cachexia; malaise; fatigue


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