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

This is VAERS ID 1152872



Case Details

VAERS ID: 1152872 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-19
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4240 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Dyspnoea, Heart rate, Investigation, Loss of consciousness, Pulmonary embolism, Pulseless electrical activity, Pupil fixed, Respiratory arrest, Right ventricular enlargement, Ultrasound scan
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Exposure to COVID-19; Penicillin allergy
Allergies:
Diagnostic Lab Data: Test Name: pulse; Result Unstructured Data: Test Result:without pulse; Test Name: investigation nos; Result Unstructured Data: Test Result:she was without a pulse and independent breathing; Comments: the pupils were dilated did not react to light; Test Name: ultrasound; Result Unstructured Data: Test Result:right ventricle enlarged
CDC Split Type: ILPFIZER INC2021330256

Write-up: loss consciousness at home later a week of breathing difficulty.; loss consciousness at home later a week of breathing difficulty.; she was without a pulse and independent breathing; Asystola/PEA/she was without a pulse; Asystola/PEA; lung embolism; the pupils were dilated did not react to light; Right ventricle enlarged; This is a spontaneous report from a contactable other health professional reporting for a patient received from the regulatory Authority. Regulatory Authority number was not provided. A 42-year-old female patient received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration on 19Jan2021 (Batch/Lot Number: EK4240) as SNIGLE DOSE for covid-19 immunisation, age of vaccination was unknown. Medical history included penicillin allergy and exposure to a confirmed ill person (COVID-19) from an unknown date. The patient''s concomitant medications were not reported. The patient was generally healthy and was allergic to penicillin. She was in quarantine because of exposure to a confirmed ill person. She was brought to a hospital while being resuscitated after she collapsed in her home. About a week ago (unspecified date) she started to suffer from difficulty breathing that became worse in the morning. After she collapsed, her partner started heart massage and alerted the emergency services staff. The ambulance team found the patient unconscious and continued with resuscitation activities (including airways and heart massage). When she was admitted to the hospital, she was without a pulse and independent breathing and the pupils were dilated did not react to light. The hospital staff continued with resuscitation activities. In a bedside ultrasound right ventricle enlarged was noted. Due to the possibility that this was a lung embolism she was treated with TPA. In the course of the long resuscitation peaks of Asystola/PEA appeared that were dealt with accordingly and also an attempt at external pace-making did not succeed. After about an hour and a half of resuscitation activity, her death was certified, and a message was sent to the partner who did not agree to conduct an autopsy after the death. She was given the first dose of the vaccine for COVID-19 it seems on 19Jan2021. Therapeutic measures were taken as a result of loss consciousness at home later a week of breathing difficulty, she was without a pulse and independent breathing, asystola/pea/she was without a pulse, asystola/pea, and lung embolism. Outcome of the events loss consciousness at home later a week of breathing difficulty, she was without a pulse and independent breathing, asystola/pea/she was without a pulse, asystola/pea was fatal. Outcome of other events was unknown. The patient died on an unspecified date. An autopsy was not performed. No follow-up attempts possible. No further information expected. Information on lot number has been obtained.; Sender''s Comments: Linked Report(s) : IL-PFIZER INC-2020517122; Reported Cause(s) of Death: she was without a pulse and independent breathing; asystola/PEA/She was without a pulse; Asystola/PEA; loss consciousness at home later a week of breathing difficulty; loss consciousness at home later a week of breathing difficulty


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