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

This is VAERS ID 1378663

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Case Details

VAERS ID: 1378663 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-05
Onset:2021-05-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY7015 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Heart rate, Oxygen saturation, Pyrexia, Slow response to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 10
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: Medical History/Concurrent Conditions: Alzheimer''s disease (GDS 6)
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:130/80; Test Name: blood pressure; Result Unstructured Data: Test Result:119/82; Test Name: body temperature; Result Unstructured Data: Test Result:38.0 Centigrade; Test Name: body temperature; Result Unstructured Data: Test Result:37.9 Centigrade; Test Name: heart beat; Result Unstructured Data: Test Result:110; Test Name: heart beat; Result Unstructured Data: Test Result:75; Test Name: oxygen saturation; Test Result: 99 %; Test Name: oxygen saturation; Test Result: 92 %
CDC Split Type: ESPFIZER INC2021590912

Write-up: Decreased reactivity; Febricula; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB and received via Regulatory Authority ES-AEMPS-864811. A 93-years-old female patient received bnt162b2 (COMIRNATY), dose 2 via an unspecified route of administration on 05May2021 (Lot Number: EY7015) as a single dose for COVID-19 immunization. Medical history included dementia alzheimer''s type (GDS 6). The patient''s concomitant medications were not reported. On 06May2021 the patient experienced decreased reactivity (slow response to stimuli), febricula. The chronological course was reported as follows: 93-Year-old patient with medical history of Alzheimer. Received Pfizer vaccine 2nd dose 48 hours ago and average temperature 37.5 ?C, temperature: 38.0 Systolic blood pressure: 130 Diastolic blood pressure: 80. Remarks: paracetamol now and I will return to store. Yesterday the fever started and they see she somewhat was less reactive. 48 hours ago 2nd dose Pfizer. Functional examination: answer questions. Arrhythmic AC without murmurs. Normal AP. Skin and mucous membranes. Paracetamol. I give advice. They will call if it persists. Temperature: 37.9 T?, place takes: Armpit. Systolic blood pressure: 119, Diastolic blood pressure: 82, Heart rate: 110, Oxygen Saturation: 99, warning for persistence of fever with normal cardiorespiratory examination continue the same with paracetamol. Home warning: low-grade fever persists (up to 37.8?C, morning) and decay. In addition, increased expectoration, something dark and occasional respiratory sounds. I give a urine collection bag but they cannot collect it. Functional examination: Sat O 92%. Arrhythmic AC (Cardiac action) without murmurs, at 75 ppm. AP(Pulmonary action) good ventilation with some isolated rhonchi. (A) PRES-E - (A) CEFUROXIMA 500 MG, Tablet, Left PCA hypoventilation. Somewhat agitated. 1 IM vial of METAMIZOL 2000 is administered at home (DUE). Control by Primary attention doctor. Pauto CEFTACIDIMA 1000 IM 1 vial / 24 hours 5 vials (visa request / authorization for benefits = control). I explain that this is usually the beginning of the end and they do not want to be transferred to the hospital. Palliative measures. I explain not to force food or drink, wet the mouth. Control Temperature. (A) PRES-E - (A) CEFTAZIDIMA 1000 MG INJECTABLE. NURSING INTERVENTIONS (NIC): Medication administration: IM: YES, Obs :: metamizole 2 gr, Home notice: since this morning without fever. Less reactive, loss of functional capacity. Do not eat nor drink. Less diuresis. Repeated movements. They do not perceive pain, nervousness, restlessness ... Functional examination: does not respond. Maintains mobility type mannerisms. AP (Pulmonary action) does not collaborate, I did not hear extra noises. Arrhythmic AC (Cardiac action) at 90 ppm. Nondescript abdomen. PPRB neg. Complains of pain with mobilization. I explain Px and measures to take into account. 24 h infusion pump: Midazolam 10 mg + Morphine 10 mg Rescue: yes nerves Midazolam 1 mg (2 ml of 5 mg in 10 cc SF) if pain Morina 1 mg (1 ml of 10 mg in 10 cc SF). 16May2021: Inactive due to death exitus at 3:00 p.m. I certify. The patient died on 16May2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. Lot/batch number was provided; Reported Cause(s) of Death: Decreased reactivity; Febricula


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