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

This is VAERS ID 1106062



Case Details

VAERS ID: 1106062 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-17
Onset:2021-02-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Death, Discomfort, Dyspnoea, Fatigue, Feeling cold, Hyperhidrosis, Loss of consciousness, Malaise, Respiratory distress
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial hypertension; Diabetes mellitus; Illness
Allergies:
Diagnostic Lab Data:
CDC Split Type: MXPFIZER INC2021253670

Write-up: arrives at this unit without vital signs; Respiratory distress/acute respiratory difficulty; loss of consciousness; discomfort; poor condition; sweating; cold; asthenia/fatigue/adynamia; asthenia/fatigue/adynamia; chills; dyspnea / respiratory distress; This is a Spontaneous report from a non-contactable healthcare professional. This is a report received from The Regulatory Authority via email. Regulatory authority report number is 9174. A 70-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number not reported), via an unspecified route of administration on 17Feb2021 at a single dose for covid-19 immunisation. Medical history included illness, diabetes mellitus (DM) and arterial hypertension (AH) from an unknown date. There were no allergies reported. Concomitant medications were not reported. The patient had COVID-19 vaccine application on 17Feb2021. On 23Feb2021, the patient experienced asthenia/fatigue/adynamia, chills, dyspnea / respiratory distress. A family member reported that after the application, she presented discomfort on an unspecified date that improved in the following days. On an unspecified date, it was reported that the patient had a normal breakfast and in the afternoon they noticed her in poor condition, sweating, cold, loss of consciousness and acute respiratory difficulty, she was treated by a private doctor and later arrived at the unit without vital signs. The family member administered a treatment or remedy prior to medical care (unspecified treatment). The patient died on an unspecified date. It was not reported if an autopsy was performed. Timeframe between vaccination and starting of symptoms was 23 days (as reported, discrepancy cannot be clarified). The outcome of the events was unknown. No follow-up attempts are possible. Information about batch/lot number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: arrives at this unit without vital signs


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