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

This is VAERS ID 1960928

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Case Details

VAERS ID: 1960928 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-11-29
Onset:2021-11-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320258D / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Headache, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHPFIZER INC202101756042

Write-up: Seizure; Fever greater than or equal to 38 degrees celsius; Headache; This is a spontaneous report received from a contactable other hcp from Regulatory Authority. Regulatory number: PH-PHFDA-300124611 Regulatory Authority. A 16-year-old male patient received BNT162B2 (COMIRNATY), intramuscular, administration date 29Nov2021 (Lot number: 320258D) at the age of 16 years as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: SEIZURE (death, life threatening) with onset 30Nov2021, outcome "fatal", described as "Seizure"; PYREXIA (death) with onset 30Nov2021, outcome "fatal", described as "Fever greater than or equal to 38 degrees celsius"; HEADACHE (death) with onset 30Nov2021, outcome "fatal", described as "Headache". The patient date of death was unknown. The reported cause of death was pyrexia, headache, seizure. 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: Fever greater than or equal to 38 degrees celsius; Headache; Seizure


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