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

This is VAERS ID 1466390

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Case Details

VAERS ID: 1466390 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-07
Onset:2021-06-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5833 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cytokine release syndrome, Cytokine test, Disseminated intravascular coagulation, Multiple organ dysfunction syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? Yes
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: cytokine; Result Unstructured Data: Test Result:increase; Comments: massive cytokine increase
CDC Split Type: DEPFIZER INC2021818098

Write-up: Disseminated intravascular coagulation; Multiple organ failure; Cytokine release syndrome; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority (RA)-WEB DE-PEI-202100116970. A 50-years-old female patient received bnt162b2 (COMIRNATY, Solution for injection) (mRNA TOZINAMERAN), dose 2 intramuscular on 07Jun2021 (Batch/Lot Number: FA5833) as DOSE 2, 0.3 ML SINGLE for covid-19 immunization. The patient medical history was not reported. There were no concomitant medications. Previously patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 07Jun2021 (Batch/Lot Number: not reported) as DOSE 1, 0.3 ML SINGLE for covid-19 immunization. On 07Jun2021 the patient experienced cytokine release syndrome, disseminated intravascular coagulation and multiple organ failure. Lab investigations includes massive cytokine increase. The patient died on an unspecified date. It was not reported if an autopsy was performed. This report is serious - death, hospitalization, life threatening. Outcome was reported as fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Cytokine release syndrome; Disseminated intravascular coagulation; Multiple organ failure


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