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

This is VAERS ID 1380215

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Case Details

VAERS ID: 1380215 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Body temperature, Death, Pain in extremity, Pyrexia, Terminal state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 0
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:
Diagnostic Lab Data: Test Date: 20210527; Test Name: body temperature; Result Unstructured Data: Test Result:38 Centigrade
CDC Split Type: ITPFIZER INC2021645702

Write-up: Death; Death imminent; Hyperthermia (38); Pains in legs; Pain in back; This is a spontaneous report downloaded from the Regulatory AUthority-WEB, regulatory authority number IT-MINISAL02-737103. A contactable physician reported that an 82-year-old female patient received BNT162B2 (COMIRNATY, solution for injection, Batch/Lot Number: FA8016; Expiration Date: 30Sep2021), dose 2 via intramuscular route (left shoulder as reported) on 22May2021 at 16:54 as 0.3 ml single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. On 27May2021, the patient experienced hyperthermia (temperature: 38 centigrade), pains in legs, death imminent, pain in back. The events were described as follows: vaccinated with 2 Pfizer dose on 22May2021, the following day, manifest hyperthermia (38) and pain in back and legs which increase until death on 27May2021. The patient died on 27May2021 and cause of death was unknown. The outcome of the events was fatal. It was not reported if an autopsy was performed. Reporter''s comments: I have been informed by the relative that expressly came to the vaccination center to report the fact. Actions taken (relative informed the vaccination center where the person had been vaccinated) - Ethnic origin (given) - COVID 19 COMIRNATY VACCINE (PFIZER) * 195 vials 0.45ML: Administration site (left shoulder) Number booster dose (2) Time of administration (16:54) Lot expiration (30Sep2021). No follow-up attempts needed. No further information expected. ; Reported Cause(s) of Death: unknown cause of death

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