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

This is VAERS ID 1064741

Case Details

VAERS ID: 1064741 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19 pneumonia, Diarrhoea, Drug ineffective, SARS-CoV-2 test, Viral test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Lack of efficacy/effect (narrow), 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), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
   Days after onset: 24
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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210121; Test Name: COVID-19 virus test; Test Result: Negative ; Test Date: 20210124; Test Name: COVID-19 virus test; Test Result: Negative ; Test Date: 20210126; Test Name: COVID-19 virus test; Test Result: Negative ; Test Date: 20210128; Test Name: COVID-19 virus test; Test Result: Negative ; Test Date: 20210130; Test Name: COVID-19 virus test; Test Result: Positive ; Test Date: 20210126; Test Name: Virus stool test; Test Result: Negative
CDC Split Type: GBPFIZER INC2021199155

Write-up: acute kidney injury; Covid pneumonitis/Covid postive; Covid pneumonitis/Covid postive; Acute diarrhea; This is a spontaneous report from a contactable physician. This is a report received from the Regulatory Agency (MHRA). Regulatory authority report number GB-MHRA-EYC 00241369, Safety Report Unique Identifier GB-MHRA-ADR 24791249. An 84-year-old male patient receive bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, lot number: EL0739), intramuscular on 14Jan2021 at 0.3 mL, single for COVID-19 immunisation. The patient medical history was not reported. Concomitant medications included allopurinol, atorvastatin calcium, bisoprolol fumarate, furosemide sodium, lisinopril anhydrous, warfarin, lisinopril. The patient experienced acute diarrhea (death) on 15Jan2021, covid pneumonitis/covid postive (death, medically significant) on 30Jan2021, acute kidney injury (death, hospitalization, medically significant) on 20Jan2021. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on 21Jan2021, COVID-19 virus test: negative on 24Jan2021, COVID-19 virus test: negative on 26Jan2021, COVID-19 virus test: negative on 28Jan2021, COVID-19 virus test: positive on 30Jan2021, Virus stool test: negative on 26Jan2021. The patient died on 08Feb2021. It was not reported if an autopsy was performed. The outcome of the events was fatal. The clinical course was reported as follows: Developed Diarrhoea. Diagnosis with acute kidney injury on 20Jan2021 and admitted to hospital. Died on 08Feb2021. Covid pneumonitis. Reporter was aware patient died of covid -but impact of vaccine on possible cause of admission reporter wish to report. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Covid pneumonitis/Covid postive; Acute kidney injury; Covid pneumonitis/Covid postive; Acute diarrhea

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