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

This is VAERS ID 1379816

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Case Details

VAERS ID: 1379816 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-16
Onset:2021-04-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiogenic shock, Dyspnoea, Fibrin D dimer, Inappropriate schedule of product administration, Myocardial infarction, Platelet count, Platelet factor 4, Pulmonary oedema, SARS-CoV-2 test negative, Troponin T
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Medication errors (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210417; Test Name: Fibrin D dimer; Result Unstructured Data: Test Result:Raised; Test Date: 202104; Test Name: Platelet count; Result Unstructured Data: Test Result:363; Comments: lowest platelet count after vaccine; Test Name: Platelet factor 4; Result Unstructured Data: Test Result:Anti-PF4 antibodies were not identified; Test Name: COVID-19 virus test; Test Result: Negative ; Test Name: Troponin T; Result Unstructured Data: Test Result:UNKNOWN
CDC Split Type: GBPFIZER INC2021620097

Write-up: Myocardial infarction; pulmonary oedema; cardiogenic shock; received the 2nd dose on 16Apr2021, 78 days from 1st dose; Increased shortness of breath; This is a spontaneous report received from a contactable physician from the Regulatory Authority (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202105251206554760-ONMNM, Safety Report Unique Identifier GB-MHRA-ADR 25355943. A 75-year-old female patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration on 16Apr2021 (Batch/Lot number was not reported) as single dose at the age of 75-year-old for covid-19 immunisation. The patient medical history and concomitant medications were not reported. No additional medical history, that relates to previous venous or arterial thromboses. The patient had no previous reactions to medications, especially heparin or anticoagulants. The patient had not confirmed or suspected autoimmune or inflammatory disease, including vasculitis. No history of, or current, malignancy and intracranial malignancy. No concurrent or recent intracranial infections. No recent surgical or medical interventions to the central nervous system (including lumbar puncture). No recent trauma/head injury. The patient previously took heparin. Vaccine history included: bnt162b2 (COMIRNATY) dose 1 on 28Jan2021 for COVID-19 immunisation. On an unspecified date the patient experienced myocardial infarction (death, medically significant), pulmonary oedema (death, medically significant), cardiogenic shock (death, medically significant). On 17Apr2021 the patient experienced increased shortness of breath (death, medically significant). The patient received the 2nd dose on 16Apr2021, 78 days from 1st dose (non serious). The course of events was as follows: Patient attended emergency department (ED) with shortness of breath on 17Apr2021 and passed away cause of death noted as: cardiogenic shock, pulmonary oedema and myocardial infarction. The patient underwent lab tests and procedures which included: fibrin D dimer: raised on 17Apr2021, platelet count: 363 (lowest platelet count after vaccine) in Apr2021, platelet factor 4: anti-pf4 antibodies were not identified, Sars-cov-2 test: negative, troponin T: unknown. Patient has not tested positive for COVID-19 since having the vaccine. No haemorrhage was identified. The patient died on 18Apr2021. It was not reported if an autopsy was performed. The reporting physician assessed that this report related to possible blood clots or low platelet counts. No follow-up Information on batch/lot number cannot be obtained attempts are possible. No further information expected. ; Reported Cause(s) of Death: Cardiogenic shock; Myocardial infarction; Pulmonary oedema


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