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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1065211

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Case Details

VAERS ID: 1065211 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-19
Onset:2021-01-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 1 LA / OT

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: 2021-02-11
   Days after onset: 17
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: Medical History/Concurrent Conditions: Anxiodepressive syndrome; Bedridden; Carcinoid tumour (vertex carcinoid, untreated); Cognitive disorder; COVID-19 virus test negative; Disease Parkinson''s; Starvation
Allergies:
Diagnostic Lab Data: Test Date: 20210118; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:negative; Test Date: 20210125; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:positive
CDC Split Type: FRPFIZER INC2021203245

Write-up: COVID-19; This is a spontaneous report from a contactable pharmacist downloaded from the Medicines Agency (MA) regulatory authority-WEB FR-AFSSAPS-LY20210735. A 90-years-old male patient received the first dose of bnt162b2 (COMIRNATY; Lot # EJ6795 ) vaccine , intramuscular in the left arm 19Jan2021 at SINGLE DOSE for covid-19 immunisation . Medical history included mixed anxiety and depressive disorder, cognitive disorder , Parkinson''s disease, starvation , carcinoid tumour (vertex carcinoid, untreated) , Sars-cov-2 test negative on 18Jan2021, bedridden . The patient''s concomitant medications were not reported. On 25Jan2021 during a systematic COVID-19 screening, the patient had a COVID PCR test positive: no symptoms presented to date. On 02Feb2021: the patient presented symptoms such as rapid breathing, fever. he was put under O2. His condition deteriorated rapidly, he presented with dehydration and a back pressure ulcer. On 05Feb2021 comfort care were implemented. On 11Feb2021 the patient died at 8 a.m. The cause of death was Covid-19. Follow up information cannot be obtained. The patient experienced covid-19 (covid-19) (death) on 25Jan2021. The patient underwent lab tests and procedures which included sars-cov-2 test: negative on 18Jan2021 , sars-cov-2 test: positive on 25Jan2021 . The action taken in response to the event(s) for bnt162b2 was not applicable. Therapeutic measures were taken as a result of covid-19 (covid-19). The patient died on 11Feb2021. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: Covid-19


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