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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1056210



Case Details

VAERS ID: 1056210 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-06
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9788 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood creatinine, Blood lactic acid, Blood urea, C-reactive protein increased, Coma, Dyspnoea, Fibrin D dimer increased, Headache, Investigation, Leukocytosis, Malaise, Oxygen saturation, Oxygen saturation decreased, Peripheral coldness, Platelet count decreased, Pulse abnormal, Renal disorder, Respiratory disorder, SARS-CoV-2 test, Thrombocytopenia, Troponin
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLEXANE; BISOPROLOL; PANTOMED [DEXPANTHENOL]; LORAMET; BEFACT [CYANOCOBALAMIN;PYRIDOXINE;THIAMINE]; MIRCERA; FOLAVIT; D-CURE; DAFALGAN FORTE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anemia; Anuria; Atrial fibrillation; Dialysis (dialysis patient (3x / week)); Heart failure; Hypoalbuminemia; Malnutrition; Pneumonia; Pulmonary edema; Renal failure; Respiratory failure; Ventricular tachycardia.
Allergies:
Diagnostic Lab Data: Test Name: Creatinine; Test Result: 3.07 mg/dl; Test Date: 20201229; Test Name: lactate; Result Unstructured Data: Test Result: increased; Test Name: Urea; Result Unstructured Data: Test Result:82.7; Test Name: crp; Result Unstructured Data: Test Result:333.3 mg/l; Test Name: dimers; Result Unstructured Data: Test Result:13600 ng/ml; Test Date: 20201229; Test Name: BD; Result Unstructured Data: Test Result:77/58; Test Name: leukocytosis; Result Unstructured Data: Test Result:16890/uL; Test Date: 20201229; Test Name: saturation; Result Unstructured Data: Test Result:84; Test Date: 20201229; Test Name: decreased platelet; Result Unstructured Data: Test Result:61000/ul; Test Date: 20201229; Test Name: pulse; Result Unstructured Data: Test Result:94; Test Date: 20201229; Test Name: Covid test; Result Unstructured Data: Test Result: negative; Test Date: 20201229; Test Name: troponin; Result Unstructured Data: Test Result:107 ng/L; Comments: increased; Test Date: 20201229; Test Name: HA; Result Unstructured Data: Test Result:25.
CDC Split Type: BEPFIZER INC2021192197

Write-up: he desatured; Cold extremities; Problem with breathing; short of breath; Thrombopenia ++; 30 min after vaccination unwell, headache; 30 min after vaccination unwell, headache; Comatose; Renal problem; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority -WEB, regulatory authority number BE-FAMHP-DHH-N2021-77530. A 73-year-old male patient received the second dose of BNT162B2 (COMIRNATY), from lot EK9788 on 06Feb2021 at single dose, via unknown route for COVID-19 immunization. The patient had received the first dose of the same vaccine on 16Jan2021 and no adverse event occurred. Relevant medical history included renal failure, dialysis patient (3x/week), heart failure and atrial fibrillation. The patient was hospitalized in Nov2020 for severe acute anuria, renal failure, heart failure, respiratory failure in the context of pulmonary edema, ventricular tachycardia, anemia, pneumonia, atrial fibrillation, malnutrition and hypo-albuminemia, socially precarious situation. Concomitant medications included enoxaparin sodium (CLEXANE), bisoprolol, dexpanthenol (PANTOMED), lormetazepam (LORAMET), cyanocobalamin, pyridoxine, thiamine (BEFACT), methoxy polyethylene glycol-epoetin beta (MIRCERA), folic acid (FOLAVIT), colecalciferol (D-CURE), paracetamol (DAFALGAN FORTE). On unknown date the patient experienced short of breath, Renal disorder, Respiratory disorder, 30 min after vaccination unwell, headache, Oxygen saturation decreased, Cold extremities, Comatose, Thrombopenia. The patient died on 07Feb2021 of the events. It was unknown if an autopsy was performed. The patient had not fever, no signs of acute infection not even the morning of vaccination. The patient underwent lab data that included Covid test on 29Dec2020: negative. Lab examination in the hospital (emergency) showed a leukocytosis of 16890/uL, a CRP of 333.3 mg/L and MDRD clearance of 20 mL/min, Urea of 82.7 and Creatinine of 3.07mg/dL. lab: increased dimers (13600ng/ml), increased troponin (107ng / l), decreased platelets (61000/ul), thrombopenia, increased lactate. BD 77/58, pulse 94, saturation 84, AH 25. He was given oxygen but did not get better. He was admitted at 2:47 pm . Intensive care and resuscitation were of no avail and the patient died in the night from 06Feb to 07Feb (exact time not known). The death was determined at 3:40 AM. The doctor did not think there was a causal relationship. Headache, malaise/ possible by FAMHP, all other events: unclassifiable by FAMHP No follow-up attempts possible. No further information expected.; Reporter''s Comments: hospitalization Nov2020: severe acute anure renal failure, heart failure, respiratory failure in the context of pulmonary edema, ventricular tachycardia, anemia, pneumonia, atrial fibrillation, malnutrition and hypo-albuminemia, socially precarious situation. frailty score: 7. no COVID infection, Covid test on 29Dec2020: negative. no reactions after first vaccination on 16Jan. poor health condition at 2nd vaccination but no fever, no signs of acute infection not even the morning of vaccination. study hospital: comatose, dyspnea, BD 77/58, pulse 94, saturation 84, AH 25. Lab examination in the hospital (emergency) showed a leukocytosis of 16890 / uL, a crp of 333.3 mg / L! and MDRD clearance of 20 mL / min, Urea of ??82.7 and Creatinine of 3.07mg / dL.. lab: increased dimers (13600ng / ml), increased troponin (107ng / l), decreased platelets (61000 / ul), thrombopenia, increased lactate. He was given oxygen but did not get better. He was admitted at 2:47 pm .; Intensive care and resuscitation were of no avail and the patient died in the night from 06Feb to 07Feb (exact time not known to me), The death was determined at 3:40 AM. doctor does not think there is a causal relationship.; Sender''s Comments: Based on the current available information, the events are most likely related to an intercurrent or underlying condition which is not related to the suspected drug BNT162B2. The case will be reassessed if additional information becomes available.; Reported Cause(s) of Death: Oxygen saturation decreased; Cold extremities; Respiratory disorder; Shortness of breath; Thrombopenia; malaise; Headache; coma; renal disorder


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