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

This is VAERS ID 1427482

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Case Details

VAERS ID: 1427482 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-05
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 9
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: Anomaly of gallbladder (Old surgical defect of the gall bladder); Bladder hypertrophy (Muscular hypertrophy of the urinary bladder (called trabecular urinary bladder)); Cardiac dilatation (Dilatation of all heart cavities); Coronary artery sclerosis; Emphysema pulmonary (Chronic emphysema); Generalised arteriosclerosis; Goitre nodular (Nodular colloid goiter with regressive changes); Left ventricular hypertrophy; Nephrosclerosis arteriolar (Arteriolosclerosis of both kidneys); Peritonitis (Chronic adhesive peritonitis)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATPFIZER INC2021681902

Write-up: Lung embolism; Deep vein thrombosis leg; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB (regulatory authority number: AT-BASGAGES-2021-30681). A 73-year-old female patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, lot number and expiry date were not reported), intramuscular on 05May2021 as 1ST DOSE, 0.3 ML SINGLE for COVID-19 immunisation. Medical history included left ventricular hypertrophy, cardiac dilatation (Dilatation of all heart cavities), emphysema pulmonary (Chronic emphysema), coronary artery sclerosis, generalised arteriosclerosis, nephrosclerosis arteriolar (Arteriolosclerosis of both kidneys), bladder hypertrophy (Muscular hypertrophy of the urinary bladder (called trabecular urinary bladder)), goitre nodular (Nodular colloid goiter with regressive changes), anomaly of gallbladder (Old surgical defect of the gall bladder), peritonitis (Chronic adhesive peritonitis). Concomitant medications were not reported. The patient experienced lung embolism (death) on May2021 and deep vein thrombosis leg (life threatening) on May2021. Outcome of the event deep vein thrombosis leg was not recovered, while outcome of lung embolism was fatal. The patient died on 10May2021. An autopsy was performed, and results were not provided. The event lung embolism was assessed as fatal, while the event deep vein thrombosis leg was assessed as life-threatening. The reporter assessed the casual relationship between Comirnaty and all reported events as possible. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Lung embolism


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