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

This is VAERS ID 1304085

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Case Details

VAERS ID: 1304085 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Abdominal wall haematoma, Cardio-respiratory arrest, Post-traumatic stress disorder, Pulmonary embolism
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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 (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 6
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:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC2021496501

Write-up: bilateral PTE (Pulmonar thromboembolism); sudden cardiorespiratory arrest due to PTSD (Post-traumatic stress disorder); PTSD (Post-traumatic stress disorder); serious hemorrhagic complication (hematoma of the abdominal wall); This is a spontaneous report received from a contactable pharmacist downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is ES-AEMPS-847195. An 89-year-old female patient received bnt162b2 (COMIRNATY) dose 1 via unknown route of administration on 31Mar2021 (Lot Number: EW2239) as 0.3 mL, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On 10Apr2021, patient without risk factors for thrombophilia was admitted for bilateral PTE (pulmonar thromboembolism) 10 days after Covid19 COMIRNATY vaccine without another trigger. Subsequently. On 14Apr2021, the anticoagulant was discontinued due to a serious hemorrhagic complication (hematoma of the abdominal wall) that required embolization. On 15Apr2021 she experienced sudden cardiorespiratory arrest due to PTSD (Post-traumatic stress disorder), with death on 16Apr2021. Cause of death was reported as pulmonar thromboembolism. The outcome of event Pulmonar thromboembolism was fatal and other events was unknown. It is unknown if autopsy was done. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Pulmonar thromboembolism

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