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

This is VAERS ID 1114013



Case Details

VAERS ID: 1114013 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-05
Onset:2021-02-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Cerebral haemorrhage, Cerebrovascular accident, Cranial nerve decompression, Hemiparesis, Loss of consciousness, Pyrexia, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ELIQUIS
Current Illness: Atrial fibrillation (Permanent); Coagulation factor inhibitor assay; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Hyperlipoproteinaemia
Allergies:
Diagnostic Lab Data: Test Date: 202012; Test Name: pos. Covid-PCR test; Result Unstructured Data: Test Result:Positive
CDC Split Type: DEPFIZER INC2021267067

Write-up: Fever; Aphasia; Cranial nerve decompression; Hemiparesis; Accident cerebrovascular; Cerebral haemorrhage; Loss of consciousness; This is a spontaneous report downloaded from the Regulatory Authority [Regulatory Authority Number DE-PEI-CADR2021018615]. A contactable consumer or other non-HCP reported that an 82-year-old female patient received the first dose of BTN162b2 (CORMINATY, Lot number unknown) intramuscularly on 05Feb2021 at single dose for COVID-19 immunisation. Relevant medical history included ongoing permanent atrial fibrillation, ongoing hypertension, ongoing coagulation factor inhibition test and COVID-19 in Dec2020. It was also reportedthat the patient had HLP. The patient had COVID-19 infection with typical symptoms and a positive PCR test in Dec2020. No concomitant medications were reported, but it was mentioned that the patient was on anticoagulation with Eliquis. On 10Feb2021 the patient experienced loss of consciousness, stroke, hemiparesis, cerebral haemorrhage, decompression of the cranial nerve. It was reported that there was acute briefing on 10Feb2021 with malignant stroke ACM right with hemiplegia left and global aphasia as well as fever. Cause of death was reported as apoplectic fit. Outcome for loss of consciousness was reported as not resolved, while it was fatal for stroke, hemiparesis, cerebral haemorrhage and decompression of the cranial nerve. Outcome of the other event was unknown. It was unknown whether an autopsy was performed. No follow-up attempts are possible, information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Apoplectic fit/Accident cerebrovascular; Cranial nerve decompression; Hemiparesis; Cerebral haemorrhage


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