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

This is VAERS ID 1104928



Case Details

VAERS ID: 1104928 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-25
Onset:2021-01-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, Dyspnoea, Incorrect route of product administration, Nasopharyngitis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Artificial cardiac pacemaker wearer; Hypertension; Overweight (light); Renal function disorder
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Covid Test; Result Unstructured Data: Test Result:Positive
CDC Split Type: DEPFIZER INC2021266942

Write-up: pneumonia with covid infektion; slight cold symptoms; Breathing difficult; Vaccine given IV; This is a spontaneous report from a non-contactable consumer or other non hcp downloaded from the Regulatory Agency-WEB DE-PEI-CADR2021015198. A 89-years-old female patient received bnt162b2 (COMIRNATY) vaccine, intravenous on 25Jan2021 (Batch/Lot number was not reported) as 0.3 mL, single for covid-19 immunisation . Medical history included ongoing renal impairment , ongoing cardiac assistance device user , ongoing hypertension , ongoing overweight light. The patient''s concomitant medications were not reported. The patient experienced pneumonia with covid infection on 26Jan2021 , slight cold symptoms on 26Jan2021 with outcome of unknown , breathing difficult on 26Jan2021 with outcome of unknown. The patient underwent lab tests and procedures which included sars-cov-2 test positive: positive. The patient died on 03Feb2021 from Covid-19 pneumonia. It was not reported if an autopsy was performed. The patient received the vaccine Intravenously and this is an Inappropriate route of vaccination. Course of event: Mild cold symptoms from the first day after vaccination, increased daily with cough and heavy breathing, no fever, admission to hospital on 5th day after vaccination in very weak condition, Corona rapid test positive, Diagnosis in hospital severe pneumonia, died 3 days after admission. According to PEI there is a consistent causal association to immunization for the event cold symptoms, but inconsistent causal association to immunization for the events pneumonia and breathing difficult. No follow-up attempts needed. Follow-up provided automatically by Agency.; Reported Cause(s) of Death: pneumonia with covid infektion


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