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

This is VAERS ID 1987607

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Case Details

VAERS ID: 1987607 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-19
Onset:2021-11-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH4752 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Diabetic ketoacidosis, Dyspnoea, Palpitations, Pyrexia, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHPFIZER INC202101798769

Write-up: Diabetic ketoacidosis; Palpitations; Difficulty of breathing; Vaccination site pain and tenderness; Vaccination site pain and tenderness; FEVER; This is a spontaneous report received from a contactable reporter(s) (Other HCP) from Regulatory Authority. Regulatory number: PH-PHFDA-300126421. A 12 year-old female patient received bnt162b2 (COMIRNATY), intramuscular, administration date 19Nov2021 (Lot number: FH4752) at the age of 12 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: DIABETIC KETOACIDOSIS (death) with onset 27Nov2021 08:00, outcome "fatal", described as "Diabetic ketoacidosis"; PALPITATIONS (death) with onset 27Nov2021 08:00, outcome "fatal", described as "Palpitations"; DYSPNOEA (death) with onset 27Nov2021 08:00, outcome "fatal", described as "Difficulty of breathing"; VACCINATION SITE PAIN (non-serious), VACCINATION SITE PAIN (non-serious) all with onset 2021, outcome "unknown" and all described as "Vaccination site pain and tenderness"; PYREXIA (non-serious) with onset 2021, outcome "recovered" (02Dec2021 13:47), described as "FEVER". The patient date of death was unknown. The reported cause of death was diabetic ketoacidosis, palpitations, dyspnoea. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Diabetic ketoacidosis; Palpitations; Difficulty of breathing


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