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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1037878



Case Details

VAERS ID: 1037878 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Ohio  
Vaccinated:2020-12-22
Onset:2020-12-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / UNK RA / OT

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Heart rate, Heart rate decreased, Oxygen saturation, SARS-CoV-2 test
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-03
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPIRIN EC; ATENOLOL; ATORVASTATIN CALCIUM; FINASTERIDE; FLOMAX [TAMSULOSIN HYDROCHLORIDE]; LANTUS; LITHIUM CARBONATE; LOSARTAN POTASSIUM; LURASIDONE HYDROCHLORIDE; OMEPRAZOLE; SERTRALINE HCL; SYNTHROID; VIT D; HALOPERIDOL; KEPPRA; TYLENOL
Current Illness: Morbid obesity (Onset Date: Admission 22Oct2020); Type 2 diabetes mellitus (Onset Date: Admission 22Oct2020)
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; BPH; Cardiac disorder; COVID-19 virus test positive; Depression; Diarrhea; Dry eyes; Epilepsy; Essential hypertension; Fall; GERD; Hyperlipidemia; Hypertension; Hypothyroidism; Pain; Restlessness; Schizophrenia
Allergies:
Diagnostic Lab Data: Test Date: 20201230; Test Name: pulse; Result Unstructured Data: Test Result:low; Test Date: 20210103; Test Name: O2; Result Unstructured Data: Test Result:increased over time; Test Date: 20201221; Test Name: Covid; Result Unstructured Data: Test Result:Positive (+)
CDC Split Type: USPFIZER INC2021157678

Write-up: Is patient deceased: Yes; Low pulse; This is a spontaneous report from two contactable nurses reporting for a patient. A 70-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number EL0140 expiration date Mar2021) intramuscular on 22Dec2020 at 10:30 at single dose in right arm for COVID-19 immunisation. The patient was vaccinated at Nursing Home. Patient age at time of vaccination was 70 years. Patient''s Medical History included ongoing Type 2 Diabetes Mellitus Without Complication onset date: admission 22Oct2020, ongoing morbid obesity due to excess calories onset date: admission 22Oct2020, cardiac disorder, essential hypertension, hypertension, schizophrenia, hyperlipidemia, benign prostatic hyperplasia (BPH), Gastrooesophageal reflux disease (GERD), depression, hypothyroid, epilepsy, pain, dry eyes, anxiety, restlessness, 17Jan2020 Slid out of chair to floor, no injury, on 27Jan2020, 28Jan2020, 29Jan2020 diarrhea noted. Concomitant medications included acetylsalicylic acid (ASPIRIN EC) for Cardiac Health, atenolol (ATENOLOL) for Essential Hypertension, atorvastatin calcium (ATORVASTATIN CALCIUM) for hyperlipidemia, finasteride (FINASTERIDE) for benign prostatic hyperplasia, tamsulosin hydrochloride (FLOMAX) benign prostatic hyperplasia, insulin glargine (LANTUS) for diabetes mellitus, lithium carbonate (LITHIUM CARBONATE) for Schizophrenia, losartan potassium (LOSARTAN POTASSIUM) for hypertension, lurasidone hydrochloride (LURASIDONE HYDROCHLORIDE) for Schizophrenia, omeprazole (OMEPRAZOLE) for gastrooesophageal reflux disease, sertraline hcl (SERTRALINE HCL) for depression, levothyroxine sodium (SYNTHROID) for hypothyroid, ergocalciferol (VIT D) for supplement, haloperidol (HALOPERIDOL) for Schizophrenia, levetiracetam (KEPPRA) for epilepsy, paracetamol (TYLENOL EXTRA-STRENGTH) for pain, propylene glycol (ARTIFICIAL TEARS) for dry eyes, lorazepam (ATIVAN) for a anxiety or restlessness. As antipyretic use was reported Tylenol ES (500 mg) Tab, 2 Tabs by Mouth Routine use three times a day given at time of vaccination and after. It was reported the patient was Covid+. He was tested on 21Dec2020 and was not admitted to hospital. Event Onset Date was reported as 24Dec2020 (clarification pending). On 30Dec2020 the patient was started on O2 at 2L for low pulse. O2 was increased over time to eventually O2 at 8L on 03Jan2021. Morphine Sulfate was started on 03Jan2021 at 5 mg sl/by mouth every 2 hours as needed for pain or airhunger. The patient deceased on 03Jan2021. The cause of death was unknown. It was not reported if an autopsy was performed. The AEs did not require a visit to Emergency Room or Physician Office. Outcome of Low pulse was unknown.; Sender''s Comments: Based on the information available the events Death (unknown cause) and Heart rate decreased are attributed to patient''s multiple underlying medical conditions including Type 2 Diabetes Mellitus, morbid obesity, cardiac disorder, hypertension, epilepsy etc. However, based solely on a vaccine-event chronological association, contributory role of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) to the above mentioned events cannot be completely excluded. The case will be reevaluated should additional information, including the cause of death, become available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Is patient deceased: Yes


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