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

This is VAERS ID 1199888



Case Details

VAERS ID: 1199888 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-01-30
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Death, Dyspnoea, Headache, Myocarditis, Neck pain, Pericardial effusion, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021370485

Write-up: Pericardial effusion; Myocarditis; Dyspnoea; Thorax pain; Tachycardia; Cervical pain; Headache; patient died; This is a spontaneous report from a non-contactable pharmacist downloaded from the regulatory authority. Regulatory authority number DE-PEI-202100029368. A 35-year-old female patient received bnt162b2 (COMIRNATY, lot number: unknown), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced pericardial effusion, myocarditis, dyspnoea, thorax pain, tachycardia, cervical pain, and headache; all on an unspecified date. The events pericardial effusion, myocarditis, dyspnoea was reported as life-threatening. The patient died on 30Jan2021. Autopsy was not performed. The patient had not recovered from the event pericardial effusion, myocarditis, dyspnoea, thorax pain, tachycardia, cervical pain, and headache. No follow-up attempts possible, batch/lot number cannot be obtained. No further information expected.; Reported Cause(s) of Death: patient died


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