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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1428704

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Case Details

VAERS ID: 1428704 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-26
Onset:2021-05-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET6956 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 15
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic lymphocytic leukaemia (cytostatic treatments); COVID-19; COVID-19 pneumonia; GERD; Hypertension
Allergies:
Diagnostic Lab Data: Test Date: 202105; Test Name: COVID-19 antigen test; Test Result: Positive
CDC Split Type: HUPFIZER INC2021730992

Write-up: COVID-19; Vaccination failure; COVID-19 pneumonia; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB. Regulatory authority number HU-OGYI-415121. A 79-years-old female patient received bnt162b2 (COMIRNATY, solution for injection, Lot Number: ET6956), via intramuscular route in the left arm on 26Apr2021 as DOSE 2, 0.3 ML, single dose for covid-19 immunization and first dose of bnt162b2 (COMIRNATY, solution for injection, Lot Number: EZ3620), via on an unspecified route of administration on 22Mar2021 as DOSE 1, single for covid-19 immunization. The patient''s medical history included hypertension, covid-19 pneumonia, chronic lymphocytic leukaemia in Feb2003 and received cytostatic treatments, covid-19 and gastrooesophageal reflux disease. The patient''s concomitant medications were not reported. The patient was hospitalized on 04May2021 after experiencing Covid-19 symptoms. Antigen test was positive. The patient received covid therapy, but her respiratory insufficiency progressed and was transferred to the Intensive Care Unit on 09May2021. Despite therapy, permanent improvement of the patients condition could not be reached. The patient passed away on 16May2021 at 18:49 due to Covid-19 pneumonia and ARDS. Sender Comment: The patient got infected with Covid-19 approximately 1 week after the second dose, therefore vaccination failure is considered possible. The case is serious because the outcome was fatal. Further information is not expected. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: ARDS; COVID-19


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