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

This is VAERS ID 1061506



Case Details

VAERS ID: 1061506 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-12
Onset:2021-02-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BEL8723 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Acute abdomen, Intestinal ischaemia, Respiratory failure, Septic shock
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Ischaemic colitis (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 0
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: Atrial fibrillation; COPD; Dementia; Hypertension arterial
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021191550

Write-up: Acute abdomen; Septic shock; Mesenteric ischaemia; Respiratory failure; This is a spontaneous report from a non-contactable physician via Regulatory Authority. An 81-year-old male patient received the first dose of bnt162b2 (COMIRNATY) (Lot no. BEL8723), intramuscular at single dose on 12Feb2021 for covid-19 immunisation. Medical history included atrial fibrillation, dementia, hypertension arterial, chronic obstructive pulmonary disease (COPD). Concomitant medications were not reported. On 13Feb2021, the patient developed acute abdomen, septic shock, mesenteric ischaemia, respiratory failure. The patient was hospitalized and condition was life threatening. The patient died on 13Feb2021. It was not reported if an autopsy was performed. Death cause was reported as mesenteric ischaemia. Comirnaty/to all events/C. Inconsistent causal association. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Mesenteric ischaemia


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