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

This is VAERS ID 1113976

Case Details

VAERS ID: 1113976 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Hypotension, Hypoxia, Pneumonia aspiration, Sepsis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Gastric cancer; Nausea
Diagnostic Lab Data:
CDC Split Type: AUPFIZER INC2021265190

Write-up: Sepsis; Hypotension; Hypoxia; Vomiting; aspiration/secondary aspiration pneumonia; This is a spontaneous report received from a contactable physician (general practitioner) from the Agency Regulatory authority number AU-TGA-0000521683). An 81 (unit unspecified) female patient received BNT162B2 (COMIRNATY; dose form reported as injection) intramuscularly on 01Mar2021 at approximately 10-11.00 Monday in aged care facility at a single dose for COVID-19 immunisation. Afebrile at the time. Medical history included gastric cancer and baseline nausea. Concomitant medications were not reported. The patient experienced aspiration/secondary aspiration pneumonia and vomiting; both with onset date 01Mar2021 (onset date to be clarified) and with outcome of fatal; hypotension and hypoxia on 02Mar2021 and with outcome of fatal, and sepsis with onset date 03Mar2021 and with outcome of fatal. The patient was well on Monday pm and Tuesday am. Vomiting Tuesday pm - nursing assessment and transferred by ambulance at 17.49hrs. Hypotension and hypoxia in hospital Haematemesis leading to hospital admission. Treatment reported as nurse assessment and hospital admission details. Sepsis diagnosed likely secondary aspiration pneumonia. Commenced on IV antibiotics noradrenalin (no response) 2 Units of blood withdrew active treatment as per families wishes and commenced palliation. The patient was transferred back to nursing home this afternoon. Discussed case with coroner office on 05Mar2021. - Palliative, no eating - commenced on morphine/midazolam. The patient passed away on 04Mar2021 at 4:00 pm. It was unknown if an autopsy was performed. Causality reported as causality possible. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: aspiration/secondary aspiration pneumonia; Sepsis; Vomiting; Hypotension; Hypoxia

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