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

This is VAERS ID 1994389

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Case Details

VAERS ID: 1994389 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-11-29
Onset:2021-11-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Headache, Seizure, Somnolence
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (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: 2021-12-05
   Days after onset: 5
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHPFIZER INC202101814664

Write-up: seizure; difficulty breathing; mild headache; sleepy; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the parent. A 13 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 29Nov2021 12:30 (Batch/Lot number: unknown) at the age of 13 years as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: SEIZURE (death, medically significant) with onset 05Dec2021 22:30, outcome "fatal", described as "seizure"; DYSPNOEA (death) with onset 05Dec2021 22:30, outcome "fatal", described as "difficulty breathing"; HEADACHE (non-serious) with onset 30Nov2021, outcome "unknown", described as "mild headache"; SOMNOLENCE (non-serious) with onset 30Nov2021, outcome "unknown", described as "sleepy". Therapeutic measures were not taken as a result of headache, somnolence. The patient date of death was 05Dec2021. The reported cause of death was dyspnoea, seizure. First day after vaccine she had mild headache and sleepy only and after 6 days at 10.30 pm while she was sleeping, her mother waked up and saw the patient had seizure and had difficulty breathing and after almost 30 mins the patient declared dead on arrival in hospital. The patient had no comorbidities she was very healthy child. The mother knew in her heart that only vaccine killed her life. Autopsy remarks Consider adverse reaction to Pfizer covid vaccine. The autopsy was performed, and results were not provided. The lot number for bnt162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: difficulty breathing; seizure


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