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

This is VAERS ID 1380534

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Case Details

VAERS ID: 1380534 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX0893 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, Dysstasia, Gait disturbance, Muscular weakness, Vital signs measurement
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 1
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: Cardiac disorder NOS; Movement disorder (The patient has had problems with movement in the past); Pacemaker insertion (cardiac); Renal disorder NOS
Allergies:
Diagnostic Lab Data: Test Date: 20210423; Test Name: vital signs; Result Unstructured Data: Test Result:without vital signs; Comments: at 14:40 the patient was found without vital signs by her family
CDC Split Type: SKPFIZER INC2021617868

Write-up: unknown cause of death; Lower extremities weakness of; unable to stand up; problem with walking; This is a spontaneous report received from a contactable consumer (patient daughter) downloaded from the Regulatory Authority-WEB. Regulatory authority number SK-SUKLSK-20214137. A 90-year-old female patient received the second dose of BNT162B2 (COMIRNATY; lot EX0893, expiry date Jul2021) intramuscular, on 22Apr2021, at 14:17, for COVID-19 immunisation. Medical history included pacemaker insertion (cardiac) from an unknown date and unknown if ongoing, movement disorder not ongoing (the patient has had problems with movement in the past), heart disease NOS from an unknown date and unknown if ongoing and kidney disease NOS. The first dose of Comirnaty was administered on an unspecified date with no adverse effect. Concomitant medications were not reported. Before the second vaccination the patient health condition was stabilised, she was regularly observed by her physician. The patient experienced adverse drug reactions 30 minutes after the second vaccination, on 22Apr2021. The patient experienced weakness of lower extremities, unable to stand up. The problem with walking lasted one hour. The reporter stated that the patient has had problems with movement in the past, but not in that extend. In the morning, on the next day after vaccination, the patient condition was better and she recovered from the previous state. On 23Apr2021 at 14:40 the patient was found without vital signs by her family. Weakness of lower extremities and unable to stand up were reported with fatal outcome. However, cause of death was unknown. Reporter''s comments: The family did not consent to an autopsy. The family consider the causality as possible. Sender Comment: Because of unknown cause of death and missing statement of pathologist, the causal relationship could not be assessed. No follow-up attempts possible. No further information expected.; Reporter''s Comments: The family did not consent to an autopsy. The family consider the causality as possible.; Reported Cause(s) of Death: unknown cause of death


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