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

This is VAERS ID 1994375

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Case Details

VAERS ID: 1994375 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Seizure
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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:
Diagnostic Lab Data:
CDC Split Type: PHPFIZER INC202101798770

Write-up: Seizure; DOB; This is a spontaneous report received from a contactable reporter(s) (Other HCP) from Regulatory Authority. Regulatory number: PH-PHFDA-300126403. A 13 year-old female patient (unknown if pregnant) received bnt162b2 (COMIRNATY), intramuscular, administration date 29Nov2021 (Lot number: FJ8760) at the age of 13 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) with onset 05Dec2021 23:00, outcome "fatal", described as "Seizure"; DYSPNOEA (death) with onset 05Dec2021 23:00, outcome "fatal", described as "DOB". The patient date of death was unknown. The reported cause of death was seizure, dyspnoea. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Seizure; DOB

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