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

This is VAERS ID 1114019



Case Details

VAERS ID: 1114019 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-01
Onset:2021-02-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Anaemia, Cardiac failure, Hyponatraemia, Ileus, Subileus, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021287921

Write-up: decompensated heart insufficiency; bridenileus; abdominal pain and vomiting; abdominal pain and vomiting; Subileus; anemia; Hyponatremia; This is a spontaneous case from a consumer''s relative included the documentation of vaccinations and a physician letter. This case created for the second vaccination. A 90-year-old female patient received bnt162b2 (COMIRNATY), second dose via an unspecified route of administration on 01Feb2021 (lot number: EJ6788) as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient previously took first dose of bnt162b2 (lot number: EJ6796) on 11Jan2021 for COVID-19 immunization, the patient experienced lymph edema of the lower E. extremities stage II, arterial hypertension on 12Jan2021; pneumonia suspected, graded as severe bronchitis, severe nausea for a longer period of time and vomiting on 21Jan2021. The patient experienced purulent bronchitis on 26Jan2021. On 26Jan2021, the patient was treated with azithromycin probatory for suspected upper respiratory tract infection previously. The reporter did not consider any relationship to the bnt162b2 vaccination. On 04Feb2021, the patient experienced anemia and hyponatremia. On 09Feb2021, the patient experienced subileus. On 09Feb2021, the patient complained of abdominal pain and vomited. During the clinical examination Ileus was suspected. This finding was confirmed as bridenileus while hospitalization. After adhesion lysis, the patient came to the intensive care unit (ICU). In ICU biventricular decompensated heart insufficiency on 09Feb2021 with fatal outcome occurred in Feb2021. The patient died on Feb2021. It was not reported if an autopsy was performed. At the time of the inpatient admission, there was no evidence of a primary pulmonary event. The outcome of event decompensated heart insufficiency was fatal, outcome of the other events was unknown. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: decompensated heart insufficiency


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