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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1304077

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Case Details

VAERS ID: 1304077 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2020-01-21
Onset:2021-04-22
   Days after vaccination:457
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW4815 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood bicarbonate, Blood creatinine, Blood glucose, Blood glucose increased, Blood lactic acid, Blood potassium, Blood pressure increased, Blood pressure measurement, Blood sodium, Body temperature, Cerebral haemorrhage, Chest X-ray, Coma scale, Coma scale abnormal, Computerised tomogram, Eosinophil count, Haematocrit, Haemoglobin, Heart rate, International normalised ratio, International normalised ratio increased, Loss of consciousness, Lymphocyte count, Mean cell volume, Monocyte count, Neutrophil count, Oxygen saturation, PCO2, PO2, Platelet count, Platelet count decreased, Pneumonia aspiration, Prothrombin level, Prothrombin level increased, Red blood cell analysis, SARS-CoV-2 test, Scan brain, Vomiting, White blood cell count, pH body fluid
SMQs:, Torsade de pointes/QT prolongation (broad), Liver-related coagulation and bleeding disturbances (narrow), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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? No
Previous Vaccinations:
Other Medications: BISOPROLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiovascular disease, unspecified (Hypertension excluded); Iron deficiency; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Name: HCO3; Result Unstructured Data: Test Result:26.9; Test Name: Creatinine; Test Result: 0.7 mg/dl; Test Name: Glucose; Test Result: 260 mg/dl; Test Date: 20210422; Test Name: Glucose; Test Result: 240 mg/dl; Test Name: Lactate ion; Result Unstructured Data: Test Result:2.4; Test Name: K; Result Unstructured Data: Test Result:4.0 mEq/l; Test Name: Blood pressure; Result Unstructured Data: Test Result:187/97 mmHg; Test Name: Sodium; Result Unstructured Data: Test Result:139 mEq/l; Test Name: temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Test Name: Chest Rx; Result Unstructured Data: Test Result:possible bronchoaspiration; Test Date: 20210422; Test Name: Thorax X-ray; Result Unstructured Data: Test Result:No signs of acute cardiopulmonary decompensation.; Comments: In both lung bases, some ill-defined millimeter nodular images are identified that in the context could be secondary to occupation of a small airway by bronchoaspiration. No signs of acute cardiopulmonary decompensation.; Test Date: 20210422; Test Name: glasgow; Result Unstructured Data: Test Result:4; Test Name: CT; Result Unstructured Data: Test Result:massive intraventricular hemorrhage; Test Name: Eosinophils; Test Result: 0.1 %; Test Name: Hematocrit; Test Result: 41.6 %; Test Name: Hemoglobin; Result Unstructured Data: Test Result:14.1 g/dl; Test Name: Heart rate; Result Unstructured Data: Test Result:79; Comments: bpm; Test Date: 20210422; Test Name: INR; Result Unstructured Data: Test Result:3.8; Test Date: 20210422; Test Name: Lymphocytes; Test Result: 8.2 %; Test Name: MCV; Result Unstructured Data: Test Result:94.5; Comments: fL; Test Name: Monocytes; Test Result: 3.0 %; Test Name: Neutrophils; Test Result: 88.5 %; Test Name: Sat O2; Test Result: 95 %; Test Name: SatO2; Result Unstructured Data: Test Result:41.6; Test Name: pCO2; Result Unstructured Data: Test Result:51.0; Test Name: pH; Result Unstructured Data: Test Result:7.345; Test Name: Platelets; Result Unstructured Data: Test Result:133.0; Comments: 10e3 / uL; Test Date: 2018; Test Name: Platelets; Result Unstructured Data: Test Result:133.0; Comments: 10e3 / uL; Test Date: 2020; Test Name: Platelets; Result Unstructured Data: Test Result:150.0; Comments: 10e3 / uL; Test Date: 20210422; Test Name: Low platelets; Result Unstructured Data: Test Result:133000; Comments: Units:/uL; Test Name: PO2; Result Unstructured Data: Test Result:26.0; Test Name: Prothrombin Activity; Result Unstructured Data: Test Result:18.0; Test Name: Red blood cells; Result Unstructured Data: Test Result:4.4; Comments: 10e3 / uL; Test Date: 20210422; Test Name: COVID-19 PCR test; Test Result: Negative ; Test Date: 20210422; Test Name: Scan brain; Result Unstructured Data: Test Result:Extensive hemoventricle with hydrocephalus; Comments: Extensive hem ventricle with hydrocephalus and transependymal transudation; Test Name: Leukocytes; Result Unstructured Data: Test Result:9.4; Comments: 9.4 10e3 / uL
CDC Split Type: ESPFIZER INC2021491305

Write-up: Haemorrhage intracerebral; Unconscious; vomiting; possible broncho aspiration; Blood pressure was 187/97 mmHg; Glasgow 4.; Glucose: 260 mg / dL; INR(international normalized ratio): 3.8; Prothrombin Activity: 18.0; Low platelets: 133000/uL; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB, regulatory authority number ES-AEMPS-842453. A 83-years-old female patient received BNT162B2 (COMIRNATY), dose 2 via an unspecified route of administration on 19Apr2021 (Batch/Lot Number: EW4815) as single dose for COVID-19 immunisation; acenocoumarol (SINTROM), oral from 21Jan2020 (Batch/Lot number was not reported) to an unspecified date, at 4 mg for atrial fibrillation. Medical history included PD of iron deficiency and type II diabetes mellitus September 2020. Reasons for the patient''s vaccination was Over 65 years of age, Cardiovascular disease (excluding HT(Hypertension)). Concomitant medication(s) included bisoprolol (BISOPROLOL) taken for an unspecified indication, start and stop date were not reported. The patient has Chronic treatment with Bisoprolol 2.5 1/2-0-0, Sintrom 4mg according to calendar. The patient previously received first dose of COMIRNATY (Lot number: ET7205) on 29Mar2021 for COVID-19 immunisation. On 22Apr2021, Patient who lived alone and had been found by a relative on the floor of her home with traces of vomiting around. BP(Blood pressure): 187/97 mmHg; Temperature 36.3 C; HR 79 bpm; Sat. O2 (%) 95; Unconscious. Glasgow 4. Summary of additional tests: Biochemistry Emergencies: Glucose: 260 mg / dL, Creatinine: 0.7 mg / dL, Sodium: 139 mEq / L, K+(Potassium): 4.0 mEq / L. Emergency blood count: Hemoglobin: 14.1 g / dL, Hematocrit: 41.6%, MCV(Mean corpuscular volume): 94.5 fL, Red blood cells: 4.4 10e3 / uL, Platelets: 133.0 10e3 / uL, Leukocytes: 9.4 10e3 / uL, Neutrophils: 88.5%, Lymphocytes: 8.2% , Monocytes: 3.0%, Eosinophils: 0.1%. Coagulation Emergencies: INR(international normalized ratio): 3.8, Prothrombin Activity: 18.0. Venous blood gases: pH: 7.345, pCO2(partial pressure of carbon dioxide): 51.0, PO2(partial pressure of oxygen): 26.0, HCO3(Bicarbonate): 26.9, SatO2(Oxygen saturation): 41.6, Lactate ion: 2.4, Image: CT(computed tomography) scan: massive intraventricular hemorrhage. Chest Rx(X/Ray): possible bronchoaspiration. Applied treatment: vitamin K. In analysis of 2018 platelets of 133.0 10e3 / uL and in 2020 150.010e3 / uL. In analysis of 2018, platelets of 133.0 10e3 / uL and in 2020, 150.010e3 / uL. On 22Apr2021, the patient had Glucose 240mg/dl, Thorax X-ray: In both lung bases, some ill-defined millimeter nodular images are identified that in the context could be secondary to occupation of a small airway by bronchoaspiration. No signs of acute cardiopulmonary decompensation, INR:3.8, lymphocytes: 8.2%, Low platelets: 133000/uL, COVID-19 PCR test was negative, Scan brain: Extensive hemoventricle with hydrocephalus and transependymal transudation. On an unknown date in 2021, the patient died. It is unknown if autopsy was done. No follow-up attempts are possible. No further information expected. Information about batch number already obtained.; Sender''s Comments: Based on temporal association, the causal relationship between BNT162B2 and the events cannot be excluded. The information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate; Reported Cause(s) of Death: Blood pressure was 187/97 mmHg; vomiting; Unconscious; Haemorrhage intracerebral; possible broncho aspiration; Glucose: 260 mg / dL; Glucose: 260 mg / dL; INR(international normalized ratio): 3.8; Prothrombin Activity: 18.0; Low platelets: 133000/uL


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