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

This is VAERS ID 1435191

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Case Details

VAERS ID: 1435191 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Anuria, Bronchitis chronic, Confusional state, Electrocardiogram, General physical health deterioration, Heart rate, Hypotonia, Pneumonia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
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: Medical History/Concurrent Conditions: Aortic valve replacement; Cardiac operation; Mitral valve repair
Diagnostic Lab Data: Test Name: ECG; Result Unstructured Data: Test Result:wide QRS; Test Name: Heart rate; Result Unstructured Data: Test Result:30 / min; Test Date: 20210527; Test Name: COVID-19 rapid POC test; Test Result: Negative
CDC Split Type: HUPFIZER INC2021752051

Write-up: bilateral pneumonia; exacerbation of chronic bronchitis; No diuresis; general condition had greatly deteriorated; confused, hypotonic; confused, hypotonic; This is a spontaneous report from a contactable physician downloaded from the WEB, the Regulatory Authority number is HU-OGYI-416521. This spontaneous, serious case was reported by a physician on 31May2021, concerning bilateral pneumonia after the administration of Comirnaty concentrate for dispersion for injection (30 micrograms of COVID-19 mRNA Vaccine, MAH: BioNTech Manufacturing GmbH/ Pfizer). On 23May2021, the 44-year-old female patient received the second dose of Comirnaty (COVID-19 mRNA Vaccine (nucleoside modified)/ Tozinameran) concentrate for dispersion for injection ( 1 dose (0.3 mL) contains 30 micrograms of COVID-19 mRNA Vaccine, intramuscularly, left arm, lot number: FA4598). First dose was given on 15Apr2021, batch number: EW4815). On 27May2021, the patient was transported to the hospital due to dyspnoea started a few days before, diarrhea complaints started 2 months before, and her general condition had greatly deteriorated. COVID-19 rapid test was negative. Due to superficial spontaneous respiration, non-invasive ventilation was started with mild sedation. The patient was confused, hypotonic, for which she received norepinephrine; she also had no diuresis. In the absence of compliance, the patient was intubated, ventilated, and given dobutamine. ECG showed wide QRS, heart rate was 30 / min, the patient was hypotonic. Tonogen (epinephrine) and atropine were given, but her heart rate did not change. Complete cardiopulmonary resuscitation was initiated, unsuccessfully. At 12:35, the patient died. According to the autopsy, the cause of death was bilateral pneumonia due to the exacerbation of chronic bronchitis. Medical history included unspecified cardiac operation when the patient was 3 years old, aortic valve replacement and mitral valve repair in //2017. The patient did not attend regular treatments. No further information is expected. Sender Comment: The patient died 4 days after the second dose of Comirnaty. The cause of death was bilateral pneumonia due to the exacerbation of chronic bronchitis. The causal relationship between the event and Comirnaty is considered unlikely. The case is serious due to fatal outcome. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Bilateral pneumonia; exacerbation of chronic bronchitis

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