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

This is VAERS ID 1469096

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Case Details

VAERS ID: 1469096 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA4597 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cholangitis, Hypophagia, Sepsis
SMQs:, Retroperitoneal fibrosis (narrow), Infectious biliary disorders (narrow), Biliary tract disorders (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 5
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: Insulin therapy; Type 2 diabetes mellitus (on insulin therapy)
Allergies:
Diagnostic Lab Data: Test Date: 20210601; Test Name: Body temperature; Result Unstructured Data: Test Result:36.4 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021800031

Write-up: Sepsis (calculous cholangitis); Sepsis (calculous cholangitis); dietary intake started to decrease; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21116614. An 94-year-old (also reported as 94-year and 5-month-old) female patient received bnt162b2 (COMIRNATY, Solution for injection, Lot Number: FA4597; Expiration Date: 31Aug2021), dose 1 via an unspecified route of administration on 01Jun2021 11:00 as single dose for covid-19 immunisation. Medical history included diabetes mellitus/type 2 diabetes mellitus and on insulin therapy. Family history was not reported. The patient''s concomitant medications were not reported. Body temperature before vaccination was 36.4 degrees centigrade. On 01Jun2021 at 11:00 (the day of vaccination), the patient received the first dose of BNT162b2. From around 06Jun2021 (5 days after the vaccination), dietary intake started to decrease. On 10Jun2021 at unknown time (9 days after the vaccination), the patient was admitted to another hospital; the reason was not reported. On 11Jun2021 at unknown time (10 days after the vaccination), the patient experienced sepsis (calculous cholangitis). On 11Jun2021 (10 days after the vaccination), the outcome of the events sepsis (calculous cholangitis) was fatal. It was not reported whether autopsy was done. Outcome of dietary intake started to decrease was unknown. The course of the events was as follows: The patient had type 2 diabetes mellitus and was on insulin therapy. On 01Jun2021 (the day of vaccination), the first vaccination was given. Thereafter, the dietary intake started to decrease from around 06Jun2021 (5 days after the vaccination). On 10Jun2021 (9 days after the vaccination), the patient was admitted to another hospital. On 11Jun2021 (10 days after the vaccination), the patient died of sepsis (calculous cholangitis). The reporting physician classified the events sepsis (calculous cholangitis) as serious (death) and assessed the causality between the events sepsis (calculous cholangitis) and BNT162b2 as unassessable. The seriousness and causality of the other event were not reported. It was not reported whether there was other possible cause of the events such as any other diseases. The reporting physician commented as follows: Made this report because of the death case despite the unknown causal relationship.; Reported Cause(s) of Death: Sepsis (calculous cholangitis); Sepsis (calculous cholangitis)


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