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

This is VAERS ID 1342855

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Case Details

VAERS ID: 1342855 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-04-14
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Myocardial infarction, Pulmonary embolism, Renal failure, Rib fracture
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiac arrhythmia; Pacemaker insertion (cardiac)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021572369

Write-up: Renal failure; Lung embolism; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; This is a spontaneous report from a non-contactable consumer. This is the second of two reports. The first report is a report downloaded from a regulatory authority [DE-PEI-CADR2021068279], Safety Report Unique Identifier [DE-PEI-202100060854]. A 91-year-old female patient received first dose of BNT162B2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date (at unknown age) as single dose for COVID-19 immunisation. Medical history included ongoing Cardiac arrhythmia, ongoing pacemaker. No known allergies. The patient''s concomitant medications were not reported. This report is serious-death. On 14Apr2021 the patient experienced Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs and was died on 14May2021 due to all above events. Also experienced Lung embolism and Renal failure on 14Apr2021 and was hospitalized on unknown date. The patient deceased in intensive care unit, cardiovascular support discontinued according to patient''s instructions and will. All events lead to emergency room visit. It was unknown if an autopsy was performed. The outcome for Heart attack, Arrest cardiac, Rib fracture was fatal, for other events was not recovered. A regulatory authority assessed the causal relationship between bnt162b2 (COMIRNATY) and all the reported events as D. Unclassifiable. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : DE-PFIZER INC-2021561204 Same reporter, same patient, different doses, different events; Reported Cause(s) of Death: Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital functions with resuscitation resulting in broken ribs; Heart attack, cardiac arrest, restored vital funct


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