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

This is VAERS ID 1065205



Case Details

VAERS ID: 1065205 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-09
Onset:2021-02-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9788 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Heart rate, Hypertension, Hyperthermia, Lung disorder, Oxygen saturation, Physical examination, SARS-CoV-2 test, Vaccination site inflammation
SMQs:, Neuroleptic malignant syndrome (broad), Accidents and injuries (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cataract; Chronic obstructive airways disease (with several episodes of infectious lung disease); COVID-19 (positive PCR COVID-19 on 30Apr2020); Hypertension arterial; Lung infection; Mixed anxiety and depressive disorder; Pneumopathy; Shoulder osteoarthritis (right shoulder); Total hysterectomy
Allergies:
Diagnostic Lab Data: Test Date: 20210215; Test Name: Blood pressure; Result Unstructured Data: Test Result:120/60 mmHg; Test Date: 20210215; Test Name: Body temperature; Result Unstructured Data: Test Result:38 Centigrade; Test Date: 20210215; Test Name: Heart rate; Result Unstructured Data: Test Result:82 BPM; Test Date: 20210215; Test Name: SpO2; Test Result: 94 %; Comments: in ascending aorta; Test Date: 20210215; Test Name: physical examination; Result Unstructured Data: Test Result:cardio nothing to report, no dyspnea; Comments: On the skin, inflammation next to the injection site (left deltoid); Test Date: 20200430; Test Name: PCR Covid-19; Test Result: Positive
CDC Split Type: FRPFIZER INC2021202959

Write-up: Hypertensive episode; Pneumopathy; Hyperthermia / fever at 38.0 ?C; Vaccination site inflammation; This is a spontaneous report from a contactable pharmacist downloaded from the Regulatory Authority-WEB (Regulatory Authority number FR-AFSSAPS-AN20210460). An 87-year-old female patient received the first single dose of BNT162B2 (COMIRNATY; lot EK9788) intramuscular, in left deltoid, on 09Feb2021, for COVID-19 immunisation. Medical history included mixed anxiety and depressive disorder, pneumopathy, hypertension arterial, cataract, chronic obstructive airways disease with several episodes of infectious lung disease, total hysterectomy, osteoarthritis of the right shoulder, all from an unknown date and unknown if ongoing. The patient was at risk of developing a severe form of COVID-19 disease (elderly). The patient had COVID-19 in 2020; she underwent a positive PCR COVID-19 on 30Apr2020 (no information on symptoms). Concomitant medications were not reported. On 15Feb2021 the patient experienced hypertensive episode, pneumopathy, hyperthermia and vaccination site inflammation. All these events were reported as serious as fatal. The clinical course of the events included the following information. On 15Feb2021, hyperthermia and hypertensive surge noticed by the nurses. At the doctor visit on 15Feb2021: fever at 38.0 ?C at the time of the examination, BP at 120/60 mmHg, HR 82 bpm, cardio nothing to report, no dyspnea, 94% sPO2 in ascending aorta, focus of right basal pneumonia. On the skin, inflammation next to the injection site (left deltoid). No biological assessment at the time of the event, no PCR Covid. Initiation of treatment with amoxicillin 3 g/day for 7 days, no modification of the anti-hypertensive treatment. The patient died on 16Feb2021. Conclusion: focus of pneumonia, hypertensive surge and hyperthermia 6 days after vaccination. Death 7 days after a first dose of Comirnaty. Summary: pneumonia, hypertensive outbreak and hyperthermia 6 days after vaccination. Death 7 days after a first dose of Comirnaty. It was unknown if an autopsy was done. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Hypertensive episode; Pneumopathy; Hyperthermia; Vaccination site inflammation


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