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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1039720

Case Details

VAERS ID: 1039720 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic kidney disease stage 3; Dry eyes; Eczema; Glaucoma; Hypertension; Prostatism; Rosacea
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021155648

Write-up: Loose stools; This is a spontaneous report from a contactable other healthcare professional. This is a report received from the RA. Regulatory authority report number GB-MHRA-WEBCOVID-202102121322200950, Safety Report Unique Identifier GB-MHRA-ADR 24749491. A 74-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: EK4176), via unspecified route of administration on 06Feb2021 at single dose for COVID-19 immunization. The relevant medical history included CKD (Chronic kidney disease) stage 3, hypertension, eczema, glaucoma, dry eyes, rosacea and prostatism, all from an unspecified date. Patient had not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient was not enrolled in clinical trial. Concomitant medications included bendroflumethiazide from 13Jan2011 for hypertension, carmellose from 20Nov2013 for dry eye, doxycycline from 10Jun2013 for rosacea, clobetasone butyrate (EUMOVATE) from 11Jul1991 for eczema, tamsulosin from 13Jun2018 for prostatism. The patient experienced loose stools on an unspecified date. The seriousness criteria was reported as death. The patient died on 12Feb2021. Case narrative: Patient found deceased at home address, loose stool around his person. Patient had not tested positive for COVID-19 since having the vaccine. The outcome of the event was fatal. No follow-up activities are possible. No further information is expected.; Reported Cause(s) of Death: loose stools

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