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

This is VAERS ID 1434481

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Case Details

VAERS ID: 1434481 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3620 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Diabetes mellitus inadequate control, Pneumonia, Renal failure, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   Days after onset: 75
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: Embolism pulmonary; Hypertension arterial; Non-insulin-dependent diabetes mellitus; Oligophrenia
Allergies:
Diagnostic Lab Data: Test Date: 20201023; Test Name: Covid-19 test; Test Result: Negative
CDC Split Type: FRPFIZER INC2021752934

Write-up: Diabetes imbalance; bronchopulmonary infection; renal failure; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB FR-AFSSAPS-LL20213978, Safety Report Unique Identifier FR-AFSSAPS-2021072790. An 83-year-old female patient received second dose of bnt162b2 (COMIRNATY), intramuscular, administered in Arm Left on 18Mar2021 (Lot Number: ET3620) as single dose for COVID-19 immunisation. Medical history included oligophrenia, embolism pulmonary, non-insulin-dependent diabetes mellitus and hypertension arterial. The patient''s concomitant medications were not reported. The patient previously received first dose of bnt162b2 (COMIRNATY) in Feb2021 for COVID-19 immunisation. On 19Mar2021, 18h after the injection, appearance of a bronchopulmonary infection with diabetes imbalance and renal failure. Patient died on 02Jun2021. The patient underwent lab tests and procedures which included Covid-19 test: negative on 23Oct2020. The patient died on 02Jun2021. It was unknown if an autopsy was performed. Additional information obtained by the Regional Pharmacovigilance Center on 2/6 after 3 reminders: in the aftermath of the vaccination (Day1Dose2), fever and deterioration of the general condition probably at the origin of a false route which led to pneumopathy, with imbalance of diabetes and acute renal failure, progression to death.; Reported Cause(s) of Death: diabetes imbalance; bronchopulmonary infection; renal failure


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