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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1380212

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Case Details

VAERS ID: 1380212 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-17
Onset:2021-05-18
   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 FA4597 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pneumonitis, Pyrexia, Renal failure, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), 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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   Days after onset: 10
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: Medical History/Concurrent Conditions: Adenocarcinoma; Hemicolectomy (for adenocarcinoma surgery)
Allergies:
Diagnostic Lab Data: Test Date: 202012; Test Name: SARS- CoV-2 infection; Result Unstructured Data: Test Result:positive
CDC Split Type: ITPFIZER INC2021645698

Write-up: Asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency; Asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency; Asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency; Asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency; Asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency; This is a spontaneous report from a contactable Physician downloaded from the regulatory authority-WEB, regulatory authority number IT-MINISAL02-736640. An 83-years-old female patient received bnt162b2 (COMIRNATY), intramuscular on 17May2021 (Batch/Lot Number: FA4597) as UNKNOWN, SINGLE DOSE for covid-19 immunisation. Medical history included hemicolectomy on Apr2021 for adenocarcinoma surgery and adenocarcinoma from an unknown date and unknown if it was ongoing. Concomitant medications were not reported. The patient experienced asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency. The patient visited emergency room for the events dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency. The events were reported as serious (fatal). The patient underwent lab tests and procedures which included covid-19: positive on Dec2020. The patient died on 28May2021. The cause of death was reported as diagnosis of pneumonia with septic shock and renal insufficiency. It was not reported if an autopsy was performed. Case narrative including clinical course, therapeutic measures, outcome and additional relevant information: On Dec 2020 infez. from SARS COV2 treated at home, in April 2021 hemicolectomy for adenocarcinoma surgery. ; Reported Cause(s) of Death: Asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia with septic shock and renal insufficiency; Asthenia, bed rest and fever, gradual worsening, 25May ER for marked dyspnoea, diagnosis of pneumonia wit


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