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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1328793

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Case Details

VAERS ID: 1328793 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Altered state of consciousness, Arrhythmia, Atrial fibrillation, Blood alkaline phosphatase, Blood bicarbonate, Blood bilirubin, Blood creatinine, Blood pH, Body temperature, C-reactive protein, COVID-19, Cardiac failure congestive, Fibrin D dimer, Glomerular filtration rate, Haemoglobin, Heart rate, Imaging procedure, International normalised ratio, Lethargy, Lymphocyte count, Microscopy, Neutrophil count, Oxygen saturation, PCO2, PO2, Platelet count, Procalcitonin, Prothrombin time, Respiratory rate, SARS-CoV-2 test, Sulphur dioxide test, Thrombocytopenia, Vaccination failure, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Haematopoietic thrombocytopenia (narrow), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), 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 (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 6
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Cataract; Chronic kidney disease; Hypertension; Osteoarthritis spinal
Diagnostic Lab Data: Test Date: 20210407; Test Name: Alk phosphatase; Result Unstructured Data: Test Result:143 IU/l; Comments: (40-104 units/L) RAISED; Test Name: HCO3; Result Unstructured Data: Test Result:22; Test Date: 20210407; Test Name: bilirubin; Result Unstructured Data: Test Result:29.6 umol/l; Comments: (0-21micromol/L) RAISED; Test Date: 20210407; Test Name: Creatinine; Result Unstructured Data: Test Result:118 umol/l; Comments: (45-84micromol/L) RAISED; Test Name: blood pH; Result Unstructured Data: Test Result:7.498; Test Date: 20210403; Test Name: Body temperature; Result Unstructured Data: Test Result:36.4; Comments: rectal; Test Date: 20210407; Test Name: C-reactive protein; Result Unstructured Data: Test Result:50.3 mg/l; Comments: RAISED; Test Date: 20210407; Test Name: D dimer; Result Unstructured Data: Test Result:563 ng/ml; Comments: (0-500ng/ml) ABNORMALLY HIGH; Test Name: GRF; Result Unstructured Data: Test Result:about 38; Test Date: 20210407; Test Name: GRF; Result Unstructured Data: Test Result:39; Comments: ml/min/1.73m2; Test Date: 20210404; Test Name: Hb; Result Unstructured Data: Test Result:10.5 g/dl; Comments: LOW; Test Date: 20210403; Test Name: heart rate; Result Unstructured Data: Test Result:54; Comments: slow AF; Test Date: 20210403; Test Name: Pulse rate; Result Unstructured Data: Test Result:54; Test Date: 20210404; Test Name: Imaging for COVID-Pneumonia; Result Unstructured Data: Test Result:No significant abnormality; Test Date: 20210404; Test Name: INR; Result Unstructured Data: Test Result:1.13; Comments: (0.94-1.06 ratio) RAISED; Test Date: 20210404; Test Name: Lymphocytes; Result Unstructured Data: Test Result:0.82 g/l; Comments: (1.3-3.6 X 109 g/L) LOW; Test Date: 20210404; Test Name: Urine microscopy; Result Unstructured Data: Test Result:E.coli ESBL positive cultivated; Test Date: 20210404; Test Name: neutrophils; Result Unstructured Data: Test Result:normal; Test Name: SPO2; Test Result: 96 %; Comments: on 15L/min Oxygen. ABGs on 15L/min NMR; Test Date: 20210403; Test Name: SPO2; Test Result: 73 %; Comments: on room air; Test Name: pCO2; Result Unstructured Data: Test Result:28.1; Test Date: 20210404; Test Name: Platelet count; Result Unstructured Data: Test Result:77; Comments: 132-349 X109/L low; Test Name: pO2; Result Unstructured Data: Test Result:79.4; Test Date: 20210407; Test Name: Procalcitonin; Result Unstructured Data: Test Result:0.137 ng/ml; Comments: (0.02-0.046 ng/mL) RAISED; Test Date: 20210404; Test Name: PT; Test Result: 11.7 s; Comments: (9.96-11.24s) RAISED; Test Date: 20210403; Test Name: Respiratory Rate; Result Unstructured Data: Test Result:28; Test Date: 20210405; Test Name: Nasal swab (RT-PCR); Test Result: Positive ; Comments: Nasal swab (RT-PCR) Detected: CT=36 Abnormal; Test Name: SO2; Result Unstructured Data: Test Result:97.2; Test Date: 20210404; Test Name: WBC; Result Unstructured Data: Test Result:normal
CDC Split Type: MTPFIZER INC2021541717

Write-up: covid-19 infection; covid-19 infection; Congestive Heart Failure; Atrial Fibrillation; Arrhythmia; Acute kidney injury; Altered consciousness; Thrombocytopenia; Increased lethargy; This is a spontaneous report from a contactable physician. A 96-years-old female patient received BNT162B2 (COMIRNATY, Solution for injection), dose 2 intramuscular, administered in Arm Left on 11Feb2021 (Lot Number: EL8723) as 2nd dose, single; dose 1 intramuscular, administered in Arm Left on 21Jan2021 (Lot Number: EM0477) as 1st dose, single for covid-19 immunisation. Medical history included hypertension, atrial fibrillation, chronic kidney disease since 2016, right eye cataract, spinal osteoarthritis. Non-smoker. Concomitant medications included atenolol at 100 mg daily; bumetanide (BURINEX) at 1 mg daily; amitriptyline hydrochloride (AMIROL) at 10 mg nocte; omeprazole at 20 mg twice daily; paracetamol at 1 g, as needed (tds) and Diarolyte sachet as needed (twice daily). The patient experienced covid-19 infection 03Apr2021. The patient was hospitalized for covid-19 infection on 03Apr2021. The patient experienced Dyspnea (Hypoxia), Tachypnea (RR more than 25bpm), Respiratory failure (Type 1 Respiratory Failure), Arrhythmia (atrial fibrillation known case), Hypoxemia (SPO2 73% RA rising to 95% on 15L/min NRM), Acute kidney injury (CKD - GFR about 38), Altered consciousness, Increased lethargy, Thrombocytopenia (Platelets - 77). On 05Apr2021 she was administered treatment with Remdesivir 200mg iv stat, then 100mg iv daily, Dexamethasone 6mg iv daily and Augmentin 1.2g 8hrly IV. The patient underwent lab tests and procedures which included: Nasal swab (RT-PCR) - positive on 05Apr2021 (new infection, Detected: CT=36 Abnormal). On admission (03Apr2021: Rectal Temp 36.4; RR=28; Pulse=54; Heart 54 - Slow AF; SpO2 on room air - 73%. Oxygen saturations rose to 96% on 15L/min Oxygen. ABGs on 15L/min NRM: pH 7.498; pCO2 28.1; pO2 79.4; SO2 97.2; HCO3 22. Imaging for COVID-Pneumonia (04Apr2021) No significant abnormality. On 04Apr2021 WBC, Neutrophils - normal, Lymphocytes 0.82 (1.3-3.6 X 109 g/L) LOW, Hb - 10.5 (12-15.5g/dL) LOW, Platelets - 77 (132-349 X109/L) LOW, PT 11.7 (9.96-11.24s) RAISED, INR 1.13 (0.94-1.06 ratio) RAISED, Imaging for COVID-Pneumonia: No significant abnormality, Urine microscopy E.coli ESBL positive cultivated. On 07Apr2021 D-DIMER 563 (0-500ng/ml) ABNORMALLY HIGH, Creatinine 118 (45-84micromol/L) RAISED, Bilirubin 29.6 (0-21micromol/L) RAISED, Alk phosphatase 143 (40-104 units/L) RAISED, GFR 39 ml/min/1.73m2, CRP 50.3 (0-5mg/L) RAISED, Procalcitonin 0.137 (0.02-0.046 ng/mL) RAISED. The patient died on 09Apr2021. It was unknown if an autopsy was performed. Cause of death: Hypoxia due to COVID-19 infection. Significant contributory causes: Congestive Heart Failure; Atrial Fibrillation. Outcome of the events covid-19 infection, Congestive Heart Failure, Atrial Fibrillation was fatal; of the other events was unknown. Follow-up attempts completed. No more information are expected.; Sender''s Comments: This patient experienced Fatal vaccination failure since a COVID-19 Infection developed 1 month 23 days days after the administration of the 2nd dose. The doses were properly spaced (42 days between the 1st and second dose).The vaccine preventable illness, COVID-19 infection, showed unfavorable course with Respiratory failure, Hypoxemia and Congestive Heart Failure, Atrial Fibrillation as significant contributory factors to the fatal outcome. Other serious events, like Arrhythmia, Acute kidney injury, Altered state of consciousness, Thrombocytopenia further worsened the clinical course of current infection. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate; Reported Cause(s) of Death: Hypoxia due to COVID-19 infection; Congestive Heart Failure; Atrial Fibrillation; Hypoxia due to COVID-19 infection

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