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

This is VAERS ID 1045017

Case Details

VAERS ID: 1045017 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 10
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: Chronic bronchitis; Living in nursing home
Diagnostic Lab Data: Test Date: 20210120; Test Name: PCR SARS-COV 2; Test Result: Positive
CDC Split Type: FRPFIZER INC2021159140

Write-up: COVID-19 aggravated/Fever/ PCR test which turns out to be positive/ suspicion of bronchitis/ deterioration of the patient''s condition; This is a spontaneous report from a contactable other HCP from the Medicines Agency (MA) regulatory authority-WEB FR-AFSSAPS-LY20210485. An 88-year-old male patient received first dose of bnt162b2 (COMIRNATY, lot number: EJ6788), intramuscularly on 19Jan2021 at single dose, for covid-19 immunisation. Medical history included chronic bronchitis, autonomy: GIR 1, and living in nursing home from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Usual treatment not known. On 19Jan2021, in the morning, 1st injection of bnt162b2, after pre-vaccination consultation. At this time, no symptoms. Stable state of health throughout the day. On 20Jan2021, faced with the presence of a fever at the end of the day, he benefits from a PCR test which turns out to be positive (but the result will not be discovered by the nursing home until 23Jan2021). On 21Jan2021, prescription of antibiotics on suspicion of bronchitis. In the following days, deterioration of the patient''s condition, with several trips to / from the hospital with return to nursing home as soon as the patient''s condition stabilizes. On 28Jan2021, hospitalization. On 30Jan2021, death. COVID-19 cluster in the facility. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 20Jan2021. The outcome of the event was fatal. The patient died on 30Jan2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: COVID-19 aggravated/Fever/ PCR test which turns out to be positive/ suspicion of bronchitis/ deterioration of the patient''s condition

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