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

This is VAERS ID 1690103



Case Details

VAERS ID: 1690103 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-27
Onset:2021-09-03
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW2246 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC202101170757

Write-up: pulmonary edema; This is a spontaneous report from a Pfizer-sponsored program, from a contactable consumer (patent''s uncle) through the Pfizer company doctor. A 14-year-old male patient received bnt162b2 (COMIRNATY), 1st dose on 06Jul2021 (Lot Number: EX0893) and 2nd dose on 27Jul2021 (Lot Number: EW2246, both via an unspecified route of administration as single dose for COVID-19 immunization. Medical history none. Concomitant medications were not reported. The patient experienced pulmonary edema (death) on 03Sep2021. The patient died on 03Sep2021. The autopsy revealed that the cause of death was pulmonary edema.; Reported Cause(s) of Death: pulmonary edema


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