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

This is VAERS ID 1065223



Case Details

VAERS ID: 1065223 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-21
Onset:2021-01-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fall, Nausea, Pelvic fracture, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteoporosis/osteopenia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: AFib (unspecified); Arteritis (unspecified transluminal angioplasty); Benign prostatic hypertrophy; Blindness (one-eye blindness after MS); Cardiac arrhythmia; Cervical root syndrome (not elsewhere classified vertebral chirp type of vascular decompression); COPD; Facial neuralgia (Neuralgia of the face under trileptosis); Fall; Hypertension arterial; Malnutrition; Neuralgia trigeminal (surgery); Prostatectomy (benign prostate hypertrophy); Sclerosis multiple (since the age of 35); Starvation; Stent placement (left primary iliac stent); Tabaquism (60 pack-year); Ulcerated varicose veins (lower limbs)
Allergies:
Diagnostic Lab Data: Test Date: 20201216; Test Name: COVID-19 virus test; Test Result: Negative
CDC Split Type: FRPFIZER INC2021197538

Write-up: Fall; Asthenia; Emesis; nauseous; pelvic fracture; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) regulatory authority-WEB FR-AFSSAPS-PC20210254. A 87-year-old male patient received bnt162b2 (COMIRNATY, lot: EJ6795), intramuscular on 21Jan2021 at single dose for covid-19 immunization. Medical history included stent placement (left primary iliac stent), Sclerosis multiple since the age of 35, chronic obstructive pulmonary disease, prostatectomy (benign prostate hypertrophy), fall, AFib (unspecified), starvation, Neuralgia trigeminal (surgery), arteritis (unspecified transluminal angioplasty), Hypertension arterial, Blindness (one-eye blindness after MS); all from unknown date and unknown if ongoing; cervical root disorders (not elsewhere classified vertebral chirp type of vascular decompression), Tabaquism (60 pack-year), Neuralgia of the face under trileptosis, Ulcerated varicose veins of the lower limbs, benign prostate hypertrophy, Cardiac arrhythmia, Undernutrition. The patient''s concomitant medications were not reported. The patient experienced fall on 22Jan2021 14:00, asthenia, emesis, nauseous, pelvic fracture on 22Jan2021; all reported as serious as death and hospitalization and resulted in emergency room visit. The day after the vaccination the patient falls at 2 p.m., has vomiting in the evening, is nauseous, asthenic. Transfer to the emergency room on 28Jan: he was diagnosed with a pelvic fracture. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on 16Dec2020. The outcome of the events was fatal. The patient died on unspecified date in 2021 due to the events. It was not reported if an autopsy was performed. No follow-up attempts are possible, no information is expected.; Reported Cause(s) of Death: Fall; Asthenia; Emesis; Nauseous; Pelvic fracture


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