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

This is VAERS ID 1991078

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Case Details

VAERS ID: 1991078 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-10-29
Onset:2021-11-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3015BA / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Anal sphincter atony, Bladder sphincter atony, Blood pressure measurement, Bradycardia, Cardiac arrest, Chest discomfort, Crepitations, Cyanosis, Dyskinesia, Dyspnoea, Jugular vein distension, Nervous system disorder, Oxygen saturation immeasurable, Postictal state, Pupils unequal, Seizure, Syncope, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Convulsions (narrow), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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: Medical History/Concurrent Conditions: Dyspnoea (PRESENTS MEDIUM TO SMALL EFFORT DYSNEA)
Allergies:
Diagnostic Lab Data: Test Date: 20211106; Test Name: Blood pressure; Result Unstructured Data: Test Result:81 mmHg
CDC Split Type: MXPFIZER INC202101813340

Write-up: afebrile seizure; syncope; neurologic deterioration; involuntary movements; loss of anal sphincter tone; loss of bladder sphincter tone; postictal state; agonizing breaths/ with breating difficulty; perioral cyanosis; peripheral cyanosis; anisochoric pupils; normolineal thorax; neck with jugular engorgement; SO2 not countable despite having O2 support with mask; discrete crepits at the base of both hemithorax; bradycardia; heart arrest; ventricular fibrillation; This is a spontaneous report received from a non-contactable reporter(s) (Other HCP) from Regulatory Authority. Regulatory number: 18239-12. A 14 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), intramuscular, administered in arm left, administration date 29Oct2021 (Lot number: 3015BA, Expiration Date: 30Nov2021) at the age of 14 years as dose 1, single for covid-19 immunisation. Relevant medical history included: "Dyspnoea" (unspecified if ongoing), notes: PRESENTS MEDIUM TO SMALL EFFORT DYSNEA. The patient''s concomitant medications were not reported. The following information was reported: SEIZURE (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "afebrile seizure"; SYNCOPE (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "syncope"; NERVOUS SYSTEM DISORDER (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "neurologic deterioration"; DYSKINESIA (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "involuntary movements"; ANAL SPHINCTER ATONY (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "loss of anal sphincter tone"; BLADDER SPHINCTER ATONY (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "loss of bladder sphincter tone"; POSTICTAL STATE (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "postictal state"; DYSPNOEA (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "agonizing breaths/ with breating difficulty"; CYANOSIS (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "perioral cyanosis"; CYANOSIS (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "peripheral cyanosis"; PUPILS UNEQUAL (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "anisochoric pupils"; CHEST DISCOMFORT (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "normolineal thorax"; JUGULAR VEIN DISTENSION (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "neck with jugular engorgement"; OXYGEN SATURATION IMMEASURABLE (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "SO2 not countable despite having O2 support with mask"; CREPITATIONS (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "discrete crepits at the base of both hemithorax"; BRADYCARDIA (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "bradycardia"; CARDIAC ARREST (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "heart arrest"; VENTRICULAR FIBRILLATION (death, hospitalization) with onset 06Nov2021, outcome "fatal", described as "ventricular fibrillation". The patient was hospitalized for seizure, syncope, nervous system disorder, dyskinesia, anal sphincter atony, bladder sphincter atony, postictal state, dyspnoea, cyanosis, cyanosis, pupils unequal, chest discomfort, jugular vein distension, oxygen saturation immeasurable, crepitations, bradycardia, cardiac arrest, ventricular fibrillation (start date: 06Nov2021). The patient underwent the following laboratory tests and procedures: blood pressure measurement: (06Nov2021) 81 mmHg. Therapeutic measures were taken as a result of seizure, syncope, nervous system disorder, dyskinesia, anal sphincter atony, bladder sphincter atony, postictal state, dyspnoea, cyanosis, cyanosis, pupils unequal, chest discomfort, jugular vein distension, oxygen saturation immeasurable, crepitations, bradycardia, cardiac arrest, ventricular fibrillation. The patient date of death was unknown. The reported cause of death was seizure, syncope, nervous system disorder, dyskinesia, anal sphincter atony, bladder sphincter atony, postictal state, dyspnoea, cyanosis, pupils unequal, chest discomfort, jugular vein distension, oxygen saturation immeasurable, crepitations, bradycardia, cardiac arrest, ventricular fibrillation. It was not reported if an autopsy was performed. Sleeping in a tripod position; presence of a surgical scar on the sternum. Advanced management of the airway was decided with the mother''s prior consent; later she presented cardiac arrest, so it was decided to start with maneuvers according to ACLS (Advanced Cardiovascular Life Support), during which she presented ventricular fibrillation on 2 occasions, meriting electrical therapy, no spontaneous return of circulation. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: afebrile seizure; syncope; neurologic deterioration; involuntary movements; loss of anal sphincter tone; loss of bladder sphincter tone; postictal state; agonizing breaths/ with breating difficulty; perioral cyanosis/peripheral cyanosis; anisochoric


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