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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1412017



Case Details

VAERS ID: 1412017 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-24
Onset:2021-06-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Pneumonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: body temperature; Result Unstructured Data: Test Result:38.1 Centigrade; Test Date: 20210603; Test Name: body temperature; Result Unstructured Data: Test Result:between 37 and 37.9 Centigrade; Comments: in the evening
CDC Split Type: JPPFIZER INC2021660401

Write-up: Pneumonia; pyrexia of 38.1 degrees Centigrade; This is a spontaneous report received from a contactable pharmacist via a Pfizer sales representative. An 87-year-old female patient received first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 24May2021 (Batch/Lot number was not reported) at age of 87-year-old as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 03Jun2021, after bnt162b2, the patient experienced pneumonia and pyrexia of 38.1 degrees Centigrade and was hospitalized on the same day. Cephem antibiotics were administered and body temperature improved to the level between 37 and 37.9 degrees Centigrade in the evening. The outcome of event was recovering. Seriousness and causality of the events were not provided. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Based on available information, a possible contributory role of the subject product, BNT162B2 vaccine, cannot be excluded for the reported events of pneumonia and pyrexia. There is limited information provided in this report. This case will be reassessed once additional information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


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