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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1037617

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Case Details

VAERS ID: 1037617 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-10
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 31
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: Food allergy; Heart disorder (something to do with the valves.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021043788

Write-up: Contracted Covid-19 with breathing difficulties; Contracted Covid-19 with breathing difficulties; This is a spontaneous report from contactable consumer (patient) and daughter via a company representative. Patient''s daughter was a Health Care Professional. A 95-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 10Jan2021, at single dose, for COVID-19 immunization. Medical history included underlying heath issues with his heart (something to do with the valves) and was allergic to mustard. The patient''s concomitant medications were not reported. The patient contracted COVID-19 on an unspecified date, in Jan2021 and was in hospital on Friday 15Jan2021 with breathing difficulties. It was reported that he contracted COVID after the vaccine had be given. However, the patient had been self-isolating and only going to his allotment in the mornings. He did however have Christmas dinner with his family Christmas day, with his daughter and son in law who are both active paramedic. They both now also have Covid and yesterday his daughter moved in with him to take care of him and she only has mild symptoms. It could be he contracted it at Christmas but the symptoms didn''t show until this week. According to the patient''s daughter, the patient went before to have the Pfizer vaccine and was asked if he had any allergies, he said he did, he was allergic to mustard. It was reported that the patient was one of the first people to be asked to get the vaccine he even cycled to the place and when he got there, they didn''t allow him because of his allergy to mustard. Accordingly, due to that the patient was not given the vaccine at that time was told that he would be contacted when the AstaZenca one was available. He had to wait for the Astrazeneca vaccine but ended up having the Pfizer one and contracted COVID. Reporter stated that if he had it 3 weeks earlier when he was supposed to would still be alive now. The patient died on an unspecified date, in Feb2021 due to COVID-19. It was unknown if autopsy was done. Information on batch number has been request. Follow-up (25Jan2021): New information reported from a consumer (daughter) via a company representative includes: medical history (allergic to mustard and additional reporter (daughter). No follow-up attempts are possible, information about batch number cannot be obtained. Follow up (11Feb2021): New information received includes: details regarding patient''s death and event''s updated.; Reported Cause(s) of Death: COVID-19; Breathing difficult


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