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

This is VAERS ID 1069329

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Case Details

VAERS ID: 1069329 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Coronary heart disease; COVID-19; Dementia; Polyneuropathy; Renal insufficiency (NINS)
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210128; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: ATPFIZER INC2021221804

Write-up: COVID-19 post Infection/COVID-19 respiratory infection/COVID-19 PCR test on 28Jan2021; COVID-19 post Infection/COVID-19 respiratory infection/COVID-19 PCR test on 28Jan2021; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB via Regulatory Authority with Regulatory Authority number: AT-BASGAGES-2021-07099. An 88-year-old male patient received first dose of bnt162b2 (COMIRNATY, Solution for injection, batch/lot number: EL1491), via an unspecified route of administration on 15Jan2021 (at unspecified age) at single dose for covid-19 immunisation. Medical history included ongoing Renal insufficiency (NINS), ongoing Polyneuropathy, ongoing COVID-19, ongoing Coronary heart disease, ongoing Dementia. The patient''s weight was not reported, and height was not reported. No concomitant medication reported. "A possible connection between deaths and COVID vaccinations carried out shortly before is suspected. The people were all vaccinated against COVID-19 on 15Jan2021 (1st vaccination with Comirnaty, batch EL1491), tested positive 4 to 13 days later (one patient 32nd Days later) and died 10 to 20 days after the vaccination (said patient 37 days later). A comparable number of deaths has not occurred in the nursing home in recent years." COVID infection has been circulating in the home since January. All 12/14 deceased have been tested positive for Sars-CoV2 by PCR. The patient in this NW report also tested positive for Sars-CoV2 by PCR (28Jan2021), then died of his COVID infection at the home on 16Feb2021. On Jan2021 the patient experienced COVID-19 death. The patient''s outcome was fatal for COVID-19. The patient died on 16Feb2021 from COVID-19 respiratory infection. The patient underwent lab tests and procedures which included COVID-19 PCR test: Positive on 28Jan2021. The patient died on 16Feb2021. An autopsy was not performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: COVID-19 respiratory infection/COVID-19 post Infection

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