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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1419968

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Case Details

VAERS ID: 1419968 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-05
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Basophil count, Blood creatinine, Blood glucose, Blood thyroid stimulating hormone, Blood urea, C-reactive protein, C-reactive protein increased, COVID-19, Death, Drug ineffective, Eosinophil count, Fibrin D dimer, Fibrin D dimer increased, Glomerular filtration rate, Glomerular filtration rate decreased, Haematocrit, Haemoglobin, Immature granulocyte count, Lymphocyte count, Mean cell haemoglobin, Mean cell haemoglobin concentration, Mean cell volume, Monocyte count, Neutrophil count, Platelet count, Red blood cell count, Red blood cell sedimentation rate, Red cell distribution width, SARS-CoV-2 test, Thyroxine free, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Lack of efficacy/effect (narrow), Haemorrhage laboratory terms (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: Absolute basophil; Result Unstructured Data: Test Result:0.04 x10 9/l; Test Date: 20210605; Test Name: basophils; Test Result: 0.6 %; Test Date: 20170622; Test Name: Creatinine; Result Unstructured Data: Test Result:62 umol/l; Test Date: 20180125; Test Name: Creatinine; Result Unstructured Data: Test Result:62 umol/l; Test Date: 20191224; Test Name: Creatinine; Result Unstructured Data: Test Result:72 umol/l; Test Date: 20210605; Test Name: Creatinine; Result Unstructured Data: Test Result:63 umol/l; Test Date: 20160921; Test Name: fasting glucose; Result Unstructured Data: Test Result:5.4 mmol/L; Test Date: 20170622; Test Name: fasting glucose; Result Unstructured Data: Test Result:4.7 mmol/L; Test Date: 20180125; Test Name: fasting glucose; Result Unstructured Data: Test Result:4.7 mmol/L; Test Date: 20180906; Test Name: fasting glucose; Result Unstructured Data: Test Result:4.6 mmol/L; Test Date: 20160921; Test Name: TSH; Result Unstructured Data: Test Result:5.71 MiU/L; Test Date: 20170622; Test Name: TSH; Result Unstructured Data: Test Result:0.39 MiU/L; Test Date: 20180125; Test Name: TSH; Result Unstructured Data: Test Result:2.59 MiU/L; Test Date: 20180906; Test Name: TSH; Result Unstructured Data: Test Result:1.87 MiU/L; Test Date: 20170622; Test Name: Urea; Result Unstructured Data: Test Result:4.7 mmol/L; Test Date: 20180125; Test Name: Urea; Result Unstructured Data: Test Result:4.9 mmol/L; Test Date: 20191224; Test Name: Urea; Result Unstructured Data: Test Result:6 mmol/L; Test Date: 20210605; Test Name: Urea; Result Unstructured Data: Test Result:3.8 mmol/L; Test Date: 20170622; Test Name: c-reactive protein; Result Unstructured Data: Test Result:2 mg/l; Test Date: 20180125; Test Name: c-reactive protein; Result Unstructured Data: Test Result:2 mg/l; Test Date: 20191224; Test Name: c-reactive protein; Result Unstructured Data: Test Result:3 mg/l; Test Date: 20210605; Test Name: c-reactive protein; Result Unstructured Data: Test Result:22 mg/l; Comments: high; Test Date: 20210605; Test Name: Absolute Eosinophil; Result Unstructured Data: Test Result:0.17 x10 9/l; Test Date: 20210605; Test Name: Eosinophils; Test Result: 2.5 %; Test Date: 20210605; Test Name: Fibrin D dimer; Result Unstructured Data: Test Result:0.86 mg/l; Comments: high; Test Date: 20170622; Test Name: eGFR (CKD-EPI); Result Unstructured Data: Test Result:90 ml/min; Test Date: 20180125; Test Name: eGFR (CKD-EPI); Result Unstructured Data: Test Result:89 ml/min; Test Date: 20191224; Test Name: eGFR (CKD-EPI); Result Unstructured Data: Test Result:73 ml/min; Test Date: 20210605; Test Name: eGFR (CKD-EPI); Result Unstructured Data: Test Result:86 ml/min; Comments: low; Test Date: 20210605; Test Name: Haematocrit; Test Result: 40.1 %; Test Date: 20210605; Test Name: Hemoglobin; Result Unstructured Data: Test Result:13.5 g/dl; Test Date: 20210605; Test Name: Immature Granuloctes abs; Result Unstructured Data: Test Result:0.01 x10 9/l; Test Date: 20210605; Test Name: Immature granulocytes; Test Result: 0.10 %; Test Date: 20210605; Test Name: Absolute lymphocytes; Result Unstructured Data: Test Result:1.09 x10 9/l; Test Date: 20210605; Test Name: Lymphocytes; Test Result: 16 %; Test Date: 20210605; Test Name: MCH; Test Result: 30.8 pg; Test Date: 20210605; Test Name: MCHC; Result Unstructured Data: Test Result:33.7 g/dl; Test Date: 20210605; Test Name: MCV; Result Unstructured Data: Test Result:91.3; Comments: fL; Test Date: 20210605; Test Name: Absolute monocytes; Result Unstructured Data: Test Result:0.88 x10 9/l; Test Date: 20210605; Test Name: Monocytes; Test Result: 12.9 %; Test Date: 20210605; Test Name: neutrophils; Test Result: 67.9 %; Test Date: 20210605; Test Name: Neutrophils abs; Result Unstructured Data: Test Result:4.63 x10 9/l; Test Date: 20210605; Test Name: Platelet count; Result Unstructured Data: Test Result:277 x10 9/l; Test Date: 20210605; Test Name: Red cell count; Result Unstructured Data: Test Result:4.39 x10 12/l; Test Date: 20210605; Test Name: ESR; Result Unstructured Data: Test Result:25; Comments: mm/hr; Test Date: 20210605; Test Name: RDW; Test Result: 13.9 %; Test Date: 20210605; Test Name: SARS-CoV-2 -PCR test; Test Result: Positive ; Test Date: 20180906; Test Name: Free T4; Result Unstructured Data: Test Result:17 pmol/L; Test Date: 20210605; Test Name: White blood cell count; Result Unstructured Data: Test Result:6.82 x10 9/l
CDC Split Type: ZAPFIZER INC2021664627

Write-up: Patient died post vaccination; SARS-CoV-2 RT-PCR positive; SARS-CoV-2 RT-PCR positive; C-Reactive Protein high; eGFR low; D-Dimer high; This is a spontaneous report from a contactable physician. A 71-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) at single dose on an unspecified date for covid-19 immunization. Medical history and concomitant medications were not reported. The patient died on an unspecified date post vaccination. On 05Jun2021, the patient had a SARS-CoV-2 -PCR test positive, C-Reactive protein high, eGFR low and D-dimer high. Lab tests included: On 21Sep2016: fasting glucose 5.4 mmol/L, TSH 5.71 MiU/L. On 22Jun2017: creatinine 62 umol/l, fasting glucose 4.7 mmol/L, TSH 0.39 MiU/L, urea 4.7 mmol/L, C-reactive protein 2 mg/l, eGFR (CKD-EPI) 90 ml/min. On 25Jan2018: creatinine 62 umol/l, fasting glucose 4.7 mmol/L, TSH 2.59 MiU/L, urea 4.9 mmol/L, C-reactive protein 2 mg/l, eGFR (CKD-EPI) 89 ml/min. On 06Sep2018: fasting glucose 4.6 mmol/L, TSH 1.87 MiU/L, free T4 17 pmol/L. On 24Dec2019: creatinine 72 umol/l, urea 6 mmol/L, C-reactive protein 3 mg/l, eGFR (CKD-EPI) 73 ml/min. On 05Jun2021: absolute basophil 0.04 x10 9/l, basophils 0.6 %, creatinine 63 umol/l, urea 3.8 mmol/L, C-reactive protein 22 mg/l (high), absolute eosinophil 0.17 x10 9/l, eosinophils 2.5 %, fibrin D dimer 0.86 mg/l (high), eGFR (CKD-EPI) 86 ml/min (low), haematocrit 40.1%, haemoglobin 13.5 g/dl, immature granuloctes abs 0.01 x10 9/l, immature granulocytes 0.10 %, absolute lymphocytes 1.09 x10 9/l, lymphocytes 16 %, MCH 30.8 pg, MCHC 33.7 g/dl, MCV 91.3 fL, absolute monocytes 0.88 x10 9/l, monocytes 12.9 %, neutrophils 67.9 %, neutrophils abs 4.63 x10 9/l, platelet count 277 x10 9/l, red cell count 4.39 x10 12/l, ESR 25 mm/hr, RDW 13.9 %, White blood cell count 6.82 x10 9/l. It was unknown if an autopsy was performed. The outcome of event patient died was fatal. The outcome of rest events was unknown.; Sender''s Comments: The causal relationship between BNT162B2 and the reported death for case unknown and the events drug ineffective and SARS-CoV-2 test positive cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes 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.; Reported Cause(s) of Death: Patient died post vaccination


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