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

This is VAERS ID 1039867



Case Details

VAERS ID: 1039867 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BUPRENORPHINE; MIDAZOLAM; HEMINEVRIN [CLOMETHIAZOLE EDISILATE]; ZOPICLONE; HIPREX [METHENAMINE HIPPURATE]; FURIX [FUROSEMIDE]; ROBINUL; MIRTAZAPINE; DUROFERON; HALDOL; MORPHINE; FOLIC ACID; MEMANTINE; METOPROLOL; ALVEDON; MINIDERM [GLYCEROL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease; Aortic valve insufficiency; Dementia; Hypertension; Late effects of cerebral stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEPFIZER INC2021151995

Write-up: breathing difficulties; wheezy breathing; Death; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) Regulatory Authority-WEB, Regulatory Authority number SE-MPA-2021-002698. Other case identifier number SE-MPA-1612445101419. A 77-year-old male patient received second dose of bnt162b2 (COMIRNATY, lot/batch number unknown), intramuscular in Feb2021 at 0.3 mL, single for covid-19 immunisation. Medical history included alzheimers disease, dementia, hypertension, aortic valve insufficiency, late effects of cerebral stroke. Patient received first dose of bnt162b2 (COMIRNATY) on 12Jan2021 for covid-19 immunisation. Concomitant medications were Alvedon, Duroferon, Furix, Haldol, Heminevrin, Hiprex, Miniderm, Robinul, acetylsalicylic acid, buprenorphine, folic acid, memantine, metoprolol, midazolam, mirtazapine, morphine, zopiclone. The reporter wrote "Patient had breathing difficulties with wheezy breathing...". The patient died within 24 hours after vaccination in Feb2021. Event reported as serious due to death. No autopsy performed. The outcome of events was fatal. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Death; breathing difficulties; wheezy breathing


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