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

This is VAERS ID 1083754



Case Details

VAERS ID: 1083754 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Drug ineffective, Systemic inflammatory response syndrome
SMQs:, Lack of efficacy/effect (narrow), Tumour lysis syndrome (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021239063

Write-up: systemic inflammatory; asymptomatic COVID-19 infection; asymptomatic COVID-19 infection; This is a spontaneous report from a non-contactable consumer. A male patient of an unspecified age received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date at single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. On an unspecified date, the patient developed a devastating systemic inflammatory response within 36 hours of receiving his second Pfizer vaccine shot. Patient''s deadly inflammatory state followed his vaccination. Administration of the Pfizer vaccine ignited a deadly inflammatory response in patient''s body acutely, in a setting where he had a recent asymptomatic COVID-19 infection. The patient died on an unspecified date. It was not reported if an autopsy was performed. Outcome of all events were fatal. No follow-up attempts are possible, information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: asymptomatic COVID-19 infection; asymptomatic COVID-19 infection; systemic inflammatory


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