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

This is VAERS ID 1104878



Case Details

VAERS ID: 1104878 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hyporesponsive to stimuli, Malaise, Pyrexia, Urosepsis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALPRIM [TRIMETHOPRIM]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: UTI (Alprim 300mg daily from 26Feb2021 for a UTI)
Allergies:
Diagnostic Lab Data:
CDC Split Type: AUPFIZER INC2021245649

Write-up: urosepsis; He was also noted to be less responsive; Felt unwell; high temperature; This is a spontaneous report from a non-contactable other HCP via agency. A 96-year-old male patient received bnt162b2 (COMIRNATY) at single dose on 04Mar2021 just before lunch (around midday) for covid-19 immunisation. Medical history included had a medical history of a number of medical conditions but the only provided was urinary tract infection treated with Alprim 300mg daily from 26Feb2021 for a UTI, was an aged care resident. No known allergies. Concomitant medication included trimethoprim (ALPRIM) 300mg daily from 26Feb2021 and ongoing for UTI, prescribed by the patient''s regular GP to be taken until 05Mar2021. The patient experienced high temperature on 05Mar2021 10:00, felt unwell on 05Mar2021 10:30, urosepsis on 05Mar2021 18:30. The patient died on 05Mar2021 18:30. It was not reported if an autopsy was performed. Clinical course was as follows: No adverse events were noted following the injection. On 05Mar2021 around 10am he began to feel unwell (high temperature), he was assessed by the RN on duty and an ambulance was called at around 11am and tansported to the Emergency Centre of hospital. He was also noted to be less responsive at this time. He went to hospital via ambulance on 05Mar2021 and passed away at 18:30 on 05Mar2021. The consumer passed away in the EC and was not admitted to Hospital at the time. Hospital advised cause of death to be urosepsis. At the time of his death the patient was on a syringe driver of unspecified medication and had a NFR (Not for resuscitation) order in place. No death certificate has been issued at this time and the coroner has been notified in line with PRIVACY Health policies on deaths following COVID vaccination. It was unclear if an autopsy and coroner''s investigation will be performed or if the GP/Hospital will issue the death certificate. It is noted that the family had provided consent to the vaccination prior to the commencement of antibiotics. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Urosepsis


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