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

This is VAERS ID 1953855

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Case Details

VAERS ID: 1953855 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA173348320218 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Dyspnoea, Myalgia, Pain, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data: Test Date: 20211118; Test Name: body temperature; Result Unstructured Data: Test Result:Fever; Comments: 20:00
CDC Split Type: PHPFIZER INC202101711249

Write-up: Dyspnea; Vomiting; Body pain; Fever; Muscle pain; Chills; This is a spontaneous report received from a contactable Other HCP from Regulatory Authority. Regulatory number: PH-PHFDA-300121720 Regulatory Authority. A 14 year-old female patient received bnt162b2 (COMIRNATY), intramuscular, administration date 18Nov2021 (Lot number: PAA1733483202180) at the age of 14 years as single dose for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: DYSPNOEA (death, hospitalization) with onset 23Nov2021 08:20, outcome "fatal", described as "Dyspnea"; VOMITING (death, hospitalization) with onset 19Nov2021 19:00, outcome "fatal", described as "Vomiting"; PYREXIA (non-serious) with onset 18Nov2021 20:00, outcome "recovered" (18Nov2021 21:00), described as "Fever"; MYALGIA (non-serious) with onset 18Nov2021 20:00, outcome "recovered" (18Nov2021 21:00), described as "Muscle pain"; CHILLS (non-serious) with onset 18Nov2021 20:00, outcome "recovered" (18Nov2021 21:00), described as "Chills"; PAIN (non-serious) with onset 23Nov2021 08:20, outcome "unknown", described as "Body pain". It reported 19Nov2021 night time: fever and vomiting; 20Nov2021 night time: fever and vomiting; 21Nov2021: No signs and symptoms; 22Nov2021 between 10-11:00 PM: Vomiting; 23Nov2021 8:20 AM: Difficulty of breathing, Vomiting (2x), Body pain. The patient date of death was 2021. The reported cause of death was dyspnoea, vomiting. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Dyspnea; Vomiting


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