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

This is VAERS ID 1978327

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Case Details

VAERS ID: 1978327 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-08
Onset:2021-11-29
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PCA0008 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Aneurysm, Cerebellar haemorrhage, Computerised tomogram, Dizziness, Headache, Loss of consciousness, Subarachnoid haemorrhage, Subdural haematoma, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-30
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: G6PD deficiency
Allergies:
Diagnostic Lab Data: Test Name: cscan; Result Unstructured Data: Test Result:unknown results
CDC Split Type: PHPFIZER INC202101769572

Write-up: the patient died of an aneurysm; cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage; cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage; cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage; severe headache; dizzy; vomited; passed out; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the parent. A 14 year-old female patient (not pregnant) received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), administration date 08Nov2021 (Lot number: PCA0008) at the age of 14 years as dose 1, single for covid-19 immunisation. Relevant medical history included: "g6pd" (unspecified if ongoing). There were no concomitant medications. Past drug history included: None, reaction(s): "Allergy", notes: Name of Drug as Reported: None, Reaction: Allergy. The following information was reported: ANEURYSM (death) with onset 30Nov2021, outcome "fatal", described as "the patient died of an aneurysm"; CEREBELLAR HAEMORRHAGE (death), SUBDURAL HAEMATOMA (death), SUBARACHNOID HAEMORRHAGE (death) all with onset 30Nov2021, outcome "fatal" and all described as "cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage"; HEADACHE (death) with onset 29Nov2021 22:00, outcome "fatal", described as "severe headache"; DIZZINESS (death) with onset 29Nov2021 22:00, outcome "fatal", described as "dizzy"; VOMITING (death) with onset 29Nov2021 22:00, outcome "fatal", described as "vomited"; LOSS OF CONSCIOUSNESS (death) with onset 29Nov2021, outcome "fatal", described as "passed out". The events "the patient died of an aneurysm", "cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage", "cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage", "cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage", "severe headache", "dizzy", "vomited" and "passed out" were evaluated at the emergency room visit. The patient underwent the following laboratory tests and procedures: computerised tomogram: unknown results. Therapeutic measures were taken as a result of aneurysm, cerebellar haemorrhage, subdural haematoma, subarachnoid haemorrhage, headache, dizziness, vomiting, loss of consciousness. The patient date of death was 30Nov2021. The reported cause of death was cerebellar haemorrhage, subdural haematoma, subarachnoid haemorrhage, aneurysm. No autopsy was performed. Additional information: This is a spontaneous report received. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not receive any other medications within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient had no allergies to medications, food, or other products. After 21 days, the patient died of an aneurysm. She was supposed to have the second dose on 29Nov2021 but it was moved to 30Nov2021. On the night of 29Nov2021, the patient complained of a severe headache, that she was dizzy, and vomited. Later on, she passed out. Patient was brought to the hospital and was DOA (dead on arrival). They managed to revive her but died the next day on 30Nov2021. Since the vaccination, the patient has not been tested for COVID-19.; Reported Cause(s) of Death: acute cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage; acute cerebellar hemorrhage, left cerebellar hemisphere with subdular hematoma and subarachnoid hemorrhage; acute cerebellar hemorrhage, left


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