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

This is VAERS ID 1086793



Case Details

VAERS ID: 1086793 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-14
Onset:2021-01-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT KNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Malaise, Pneumonia aspiration, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 48
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENDROFLUMETHIAZIDE; PERINDOPRIL; SALBUTAMOL; SERTRALINE; SIMVASTATIN; TRELEGY
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Aortic aneurysm; BPH; Depression; Fall (admitted to hospital); Hearing impaired; Hospitalization (due to fall); Sarcopenia; Steroid therapy (Taking regular steroid treatment (e.g. orally or rectally)); Type II diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Date: 20210213; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021244100

Write-up: aspiration pneumonia; Fatigue; unwell; This is a spontaneous report from a contactable physician. This is a report received from the Agency Regulatory Authority. Regulatory authority report number GB-MHRA-WEBCOVID-202103031538237850, Safety Report Unique Identifier GB-MHRA-ADR 24869685. A 91-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot/batch number and expiry date were not known) solution for injection, via an unspecified route of administration on 14Jan2021 at a single dose for Covid-19 immunization. Medical history included fall (admitted to hospital), aortic aneurysm, depression, anxiety, benign prostatic hyperplasia (BPH), steroid therapy (taking regular steroid treatment (e.g. orally or rectally)), type 2 diabetes mellitus from an unknown date and unknown if ongoing, hearing impaired from an unknown date and unknown if ongoing, and sarcopenia from an unknown date and unknown if ongoing. Concomitant medication included bendroflumethiazide for hypertension, perindopril for hypertension, salbutamol for COPD (Chronic obstructive pulmonary disease), sertraline, simvastatin, fluticasone furoate, umeclidinium bromide, vilanterol trifenatate (TRELEGY) for COPD (Chronic obstructive pulmonary disease). Unsure if patient has had symptoms associated with COVID-19. Unsure if patient was enrolled in clinical trial. The family stated that the patient became unwell shortly after receiving his Covid vaccine on 14Jan2021. He was fatigued on 15Jan2021. Patient had a fall (prior to vaccination) and was then admitted to hospital. In the hospital he was treated for possible aspiration pneumonia on an unknown date, but he failed to respond to the treatment. Patient died on 03Mar2021 due to aspiration pneumonia. The events caused prolonged hospitalization, considered life-threatening, and medically significant. The patient underwent lab tests which included COVID-19 virus test: no - negative covid-19 test on 13Feb2021. Outcome of the event aspiration pneumonia was fatal while unwell and fatigue was unknown. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Aspiration pneumonia


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