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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1377607

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Case Details

VAERS ID: 1377607 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-06
Onset:2021-04-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3674 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, SARS-CoV-2 test, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Adipositas per magna; Arterial hypertension; Chronic diarrhea; Chronic renal insufficiency (stage III); Hypochromic microcytic anemia; Ulcer of lower limbs, excl decubitus ulcer; Urinary tract infection
Preexisting Conditions: Medical History/Concurrent Conditions: Alcohol addiction
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: DEPFIZER INC2021590652

Write-up: Acute renal failure; Septic shock; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority-WEB, regulatory authority number DE-PEI-202100071817. A 68-year-old female patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on 06Apr2021 (at age 68-years-old) (Batch/Lot Number: ET3674) as 2nd dose, 0.3 mL, single for covid-19 immunisation. The first dose was received on 25Feb2021 at age 68-years-old. Medical history included urinary tract infection from Mar2021 and ongoing, alcohol addiction, ongoing chronic kidney disease stage III, ongoing hypochromic anaemia, ongoing chronic diarrhea , ongoing arterial hypertension, ongoing Adipositas per magna, and ongoing ulcer of lower limbs, excl decubitus ulcer. The patient''s concomitant medications were not reported. The patient experienced acute renal failure and septic shock on 10Apr2021 which resulted in death. The patient underwent lab tests and procedures which included COVID-19 PCR test: positive on Jan2021. The patient died on 12Apr2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Acute renal failure; septic shock


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