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

This is VAERS ID 1067746



Case Details

VAERS ID: 1067746 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-02-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Dyspnoea, Hypotension, Pneumonia, Renal failure, Scan brain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (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 (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Prostate cancer metastatic; Single functional kidney
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Neoplasm (Recently had treatment for cancer, leukaemia or lymphoma (radiotherapy or chemotherapy)); Pneumonia; Prostate cancer; Stroke; Suspected COVID-19; Comments: I do not know the list of his medication but he had high blood pressure and was on medication to lower it and also for prostate cancer. He had been on these medications for years. He no longer took medication for diabetes, which he had controlled through diet Not had a COVID-19 test Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data: Test Name: brain scan; Result Unstructured Data: Test Result:showing recent stroke
CDC Split Type: GBPFIZER INC2021205321

Write-up: Death; failing kidneys; low blood pressure; breathing difficulty; pneumonia; stroke; This is a spontaneous report from a contactable consumer (reporting for his father) via the Medicines & Healthcare products Regulatory Agency (MHRA). Regulatory authority report number GB-MHRA-WEBCOVID-202102222122092960, Safety Report Unique Identifier GB-MHRA-ADR 24818088. A 92-years-old male patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in Jan2021 at single dose for covid-19 immunisation. Medical history included prostate cancer, pneumonia, cerebrovascular accident, hypertension, ongoing diabetes mellitus, suspected covid-19 from 06Apr2020 to 12Apr2020 (as reported), neoplasm (recently had treatment for cancer, leukaemia or lymphoma (radiotherapy or chemotherapy)). The patient''s concomitant medications were not reported. Text for relevant medical history and concurrent conditions: The reporter did not know the list of his medications but he had high blood pressure and was on medication to lower it and also for prostate cancer. He had been on these medications for years. He no longer took medication for diabetes, which he had controlled through diet. The patient experienced death on 01Feb2021 (as reported) and stroke on unknown date in 2021 with outcome of unknown. The patient died on 22Feb2021. The cause of death was unknown (as reported). It was not reported if an autopsy was performed. It was reported that the patient (aged 92) was recommended to have the Pfizer vaccine in December by his GP, even though he had prostate cancer which had progressed to his bones, had one functioning kidney and he had been diabetic. He was not in a care home, saw very few people and he had COVID and survived it, back in March (as reported). He had the second jab 3-4 weeks before and 3 days after the jab that felt ill and fell. He then took to bed, with freezing hands, unable to eat and completely wasted away. On 16Feb2021, with failing kidneys and low blood pressure, he was rushed to hospital where they stabilised him enough to find that he had had a stroke three weeks before. Brain scan showing recent stroke. He developed breathing difficulties and died on 22Feb2021, not from COVID but pneumonia (they were informed, as reported). Patient has not tested positive for COVID-19 since having the vaccine. No follow-up attempts possible; information regarding batch/lot cannot be obtained; No further information expected.; Reported Cause(s) of Death: pneumonia; death


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