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

This is VAERS ID 1960942

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Case Details

VAERS ID: 1960942 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-11-15
Onset:2021-11-16
   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 PCB0002 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Decreased appetite, Diarrhoea, Dyspnoea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), 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:
CDC Split Type: PHPFIZER INC202101756074

Write-up: vomiting non projectile/Vomiting x10 episodes; undocumented low grade fever; loss of appetite; generalized abdominal pain; difficulty of breathing; LBM watery non mucoid, non bloody/LBM x3 episodes; generalized body weakness; This is a spontaneous report received from a contactable reporter(s) (Other HCP) from Regulatory Authority. Regulatory number: PH-PHFDA-300122591. A 15 year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administration date 15Nov2021 (Lot number: PCB0002) at the age of 15 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: ASTHENIA (death, hospitalization) with onset 16Nov2021, outcome "fatal", described as "generalized body weakness"; VOMITING (death, hospitalization) with onset 18Nov2021, outcome "fatal", described as "vomiting non projectile/Vomiting x10 episodes"; PYREXIA (death, hospitalization) with onset 18Nov2021, outcome "fatal", described as "undocumented low grade fever"; DECREASED APPETITE (death, hospitalization) with onset 18Nov2021, outcome "fatal", described as "loss of appetite"; ABDOMINAL PAIN (death, hospitalization) with onset 18Nov2021, outcome "fatal", described as "generalized abdominal pain"; DYSPNOEA (death, hospitalization) with onset 18Nov2021, outcome "fatal", described as "difficulty of breathing"; DIARRHOEA (death, hospitalization) with onset 18Nov2021, outcome "fatal", described as "LBM watery non mucoid, non bloody/LBM x3 episodes". On 19Nov2021, Persistence vomiting, (+) abdominal pain, (+) DOB. The patient date of death was unknown. The reported cause of death was asthenia, vomiting, pyrexia, decreased appetite, abdominal pain, dyspnoea, diarrhoea. 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: generalized abdominal pain; LBM watery non mucoid, non bloody; difficulty of breathing; generalized body weakness; vomiting non projectile; undocumented low grade fever; loss of appetite


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