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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1339150

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Case Details

VAERS ID: 1339150 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, COVID-19, COVID-19 pneumonia, Cardiac failure, Chest X-ray, Multiple organ dysfunction syndrome, Respiratory failure, SARS-CoV-2 test, Shock
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 17
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: ADEXOR; ELIQUIS
Current Illness: Fatty liver; Gastroesophageal reflux; NIDDM; Obesity
Preexisting Conditions: Medical History/Concurrent Conditions: Choroid neoplasm; Pulmonary embolism
Diagnostic Lab Data: Test Date: 20210316; Test Name: Chest X-ray; Result Unstructured Data: Test Result:COVID-19 pneumonia; Comments: diagnose of COVID-19 pneumonia; Test Date: 20210316; Test Name: SARS-CoV-2 test positive; Test Result: Positive ; Comments: diagnose of COVID-19; Test Name: Body temperature; Result Unstructured Data: Test Result:fever (unknown value)
CDC Split Type: HUPFIZER INC2021560200

Write-up: respiratory failure; shock; multiple organ failure; heart failure; COVID-19; COVID-19 pneumonia; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB, regulatory authority number HU-OGYI-288321. A 72-year-old female patient received first dose of BNT162B2 (COMIRNATY), intramuscular, administered in arm left on 04Mar2021 (Batch/Lot Number: ET1831) as 0.3 mL single dose for COVID-19 immunisation. Medical history included ongoing type 2 diabetes mellitus (NIDDM), pulmonary embolism in 2016, ongoing gastrooesophageal reflux disease, ongoing fatty liver, choroid neoplasm from an unknown date and unknown if ongoing and ongoing obesity. Concomitant medications included trimetazidine hydrochloride (ADEXOR, strength: 80 mg ) at 80 mg once a day and apixaban (ELIQUIS, strength: 2.5 mg) at 2.5 mg twice a day, both taken for an unspecified indication, start and stop date were not reported. On an unspecified date the patient experienced fever and dyspnoea. On 11Mar2021, the patient was hospitalized. On 16Mar2021, the patient''s COVID-19 test was positive. On the same day, chest X-ray showed COVID-19 pneumonia. The patient''s condition worsened with time in the hospital. In the hospital, the patient received medicinal therapy as antibiotics, antiviral therapy, steroids, mucolytic medicines, mucus protective medicines, LMWH and oxygen therapy. The course of the disease was critical, the patient had respiratory failure, shock and multiple organ failure. On 02Apr2021, the patient died. According to the patient''s death certificate, the direct cause of death was heart failure. The primary disease that caused the patient''s death was COVID-19, which escalated to COVID-19 pneumonia and respiratory failure. It was not reported if an autopsy was performed. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: heart failure; COVID-19 pneumonia; covid-19; respiratory failure; shock; multiple organ failure

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