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From the 10/8/2021 release of VAERS data:

This is VAERS ID 971333



Case Details

VAERS ID: 971333 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6796 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary embolism, SARS-CoV-2 test, Urinary retention, Vaginal discharge
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-31
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CANDESARTAN; ITERIUM; RISPERIDON SANDOZ; NOVALGIN [METAMIZOLE SODIUM]; LAXOGOL; PASPERTIN [METOCLOPRAMIDE HYDROCHLORIDE]; DULCOLAX [SODIUM PICOSULFATE]; THYREX; MEMANTINE; DOXAZOSIN HEXAL; DUROTIV; LAEVOLAC; TRAJENTA; DOMINAL [ACETYLSALICYL
Current Illness: Arteriosclerosis (severe general atherosclerosis); Decompensation cardiac (Cardiac decompensation); Deep vein thrombosis (deep vein thrombosis on both sides); Dementia; Diabetes mellitus (Diabetes mellitus - treated with medication, values were in the normal range); Emphysema pulmonary (highly chronic obstructive pulmonary emphysema); Hypertension (Hypertension values were checked once a day for the last few days. controlled, and were also in the normal range - 130/80 Heart rate 74 / min); Retention cyst
Preexisting Conditions: Medical History/Concurrent Conditions: Adnexectomy (Status post adnexectomy); Appendectomy (Status post appendectomy); Cholecystectomy (Status post cholecystectomy); COVID-19 PCR test positive (The patient was tested positive for Corona by means of PCR on November 25, 2020 and was officially segregated until December 10, 2020. PCR from December 7th, 2020 negative.); Hysterectomy (Status post hysterectomy); Pneumonia (Condition after pneumonia right subfield in July 2020 - the oxygen saturation was checked daily and was 93%); Strumectomy (Condition after strumectomy with substitution)
Allergies:
Diagnostic Lab Data: Test Date: 20201125; Test Name: COVID-19 PCR test; Result Unstructured Data: Test Result:POSITIVE; Test Date: 20201207; Test Name: COVID-19 PCR test; Result Unstructured Data: Test Result:NEGATIVE
CDC Split Type: ATPFIZER INC2021054438

Write-up: massive central pulmonary embolism of the A. pulmonaris dexter and sinister; brownish vaginal discharge; no urine; This is a spontaneous report from a contactable healthcare professional/ physician downloaded from the Medicines Agency (MA) Regulatory Authority-WEB. The regulatory authority report number AT-BASGAGES-2021-00009. An 87-year-old female patient BNT162B2 (COMIRNATY; Lot number EJ6796), via an unspecified route of administration on 28Dec2020 as single dose for COVID-19 immunization. The patient''s medical history and concurrent conditions included: COVID-19 PCR test positive on 25NOV2020, diabetes mellitus (continuing; treated with medication, values were in the normal range), hypertension (continuing; hypertension values were checked once a day for the last few days, controlled, and were also in the normal range - 130/80, Heart rate 74 / min), decompensation cardiac (continuing), pneumonia (Condition after pneumonia right subfield in Jul2020 - the oxygen saturation was checked daily and was 93%), dementia (continuing), Arteriosclerosis (continuing; severe general atherosclerosis), Strumectomy (Condition after strumectomy with substitution), Deep vein thrombosis (continuing; deep vein thrombosis on both sides), Emphysema pulmonary (continuing; highly chronic obstructive pulmonary emphysema), Cholecystectomy (Status post cholecystectomy), Appendectomy (Status post appendectomy), Hysterectomy (Status post hysterectomy), Adnexectomy (Status post adnexectomy), retention cyst (continuing). Concomitant medication included candesartan (MANUFACTURER UNKNOWN) from 21JUL2020, rilmenidine (ITERIUM) for 10JUN2020, risperidone (RISPERIDON SANDOZ), metamizole sodium (NOVALGIN [METAMIZOLE SODIUM]) for musculoskeletal pain from 05APR2019 and 27JUL2020 and , macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (LAXOGOL) from 13DEC2019, metoclopramide hydrochloride (PASPERTIN) from 15JUL2020, sodium picosulfate (DULCOLAX) from 06AUG2019, levothyroxine sodium (THYREX) from 23JUN2019, memantine (MANUFACTURER UNKNOWN) from 16JUL2020, doxazosin mesilate (DOXAZOSIN HEXAL) from 09JUN2020, esomeprazole (DUROTIV) from 03FEB2020, lactulose (LAEVOLAC), linagliptin (TRAJENTA) from 05APR2019, acetylsalicylic acid (DOMINAL) from 18NOV2019, sertraline hydrochloride (SERTRALIN BLUEFISH) from 05JUN2020, colecalciferol (OLEOVIT D3) from 15JUL2019, magnesium carbonate, magnesium oxide (MAGNOSOLV) from 05APR2019, calcium chloride, potassium chloride, sodium chloride (RINGER FRESENIUS) from 17DEC2019, ambroxol hydrochloride (AMBROBENE) for coughing from 09JUN2020, levothyroxine sodium (THYREX) for coughing from 22JUN2019. The patient experienced massive central pulmonary embolism of the a. pulmonaris dexter and sinister on 23Jan2020 which was serious as it had fatal outcome; she also experienced brownish vaginal discharge on 30Dec2020 with outcome of unknown; Patient had no urine on 29Dec2020 with outcome of recovered on 29Dec2020. The patient underwent lab tests and procedures which included history COVID-19 PCR test that was positive on 25Nov2020 and COVID-19 PCR test again on 07Dec2020 was negative. Clinical course was as follows: the patient received BNT162B2 on 28Dec2020, then on 30Dec2020, the patient experienced vaginal discharge abnormality. On 29Dec2020, the patient experienced urinary retention. On 31Dec2020, at 03:45 the patient experienced recurrent pulmonary embolism death. The patient died from recurrent pulmonary embolism. BASGAGES follow up autopsy findings from reported the cause of death as massive central pulmonary embolism of A. pulmonalis dext et sin. The patient died on 31Dec2020. Sender''s comments: BASGAGES comment from 7.1.2020: Data capture aid form of Pfizer taken into consideration for further request of FU. Cause of death and Autopsy findings requested. Confounding factors: elderly age, underlying diabetes mellitus, hypertension, decompensation cardiac, deep vein thrombosis, etc The causal relationship between the product Comirnaty and pulmonary embolism is assessed as unlikely. The information provided in this individual case does not warrant a change in the product information or other measures. The case will be closed at this time. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Recurrent pulmonary embolism


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