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

This is VAERS ID 1056156



Case Details

VAERS ID: 1056156 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-04
Onset:2021-02-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0725 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Body temperature increased, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210204; Test Name: Body temperature increased; Result Unstructured Data: Test Result:38.3 Centigrade; Comments: acme
CDC Split Type: ITPFIZER INC2021180663

Write-up: Vomiting; fever (acme 38.3 ? c); Acute respiratory insufficiency/respiratory failure; This is a spontaneous report from a contactable physician downloaded from the regulatory authority- IT-MINISAL02-678861. An 83-year-old male patient received the second dose of bnt162b2 (COMIRNATY, Solution for injection, batch/lot number: EL0725, expiration date: 31Mar2021), intramuscular on 04Feb2021 at single dose (1 dose form) in left arm (reported as "left shoulder") for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 04Feb2021, the patient experienced Fever (acme 38.3 Centigrade), Vomiting, Acute respiratory insufficiency. The adverse reaction was severe and the outcome was patient was death. The patient died on 07Feb2021. It was unknown if an autopsy was performed. Reporter comment: Hyperpyrexia and vomiting appeared about 5 hours after the administration of the anti-SARS-Cov2 vaccine. After about 36 hours, respiratory failure with the need for oxygen therapy. The outcome of the events was fatal.; Reporter''s Comments: Hyperpyrexia and vomiting appeared about 5 hours after the administration of the anti-SARS-Cov2 vaccine . After about 36 hours, respiratory failure with the need for oxygen therapy.; Reported Cause(s) of Death: Acute respiratory insufficiency/respiratory failure; Fever (acme 38.3 Centigrade); Vomiting


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