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

This is VAERS ID 1106949



Case Details

VAERS ID: 1106949 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-09
Onset:2021-02-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0725 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fall, Gait inability, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 7
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LORADUR; TRITACE; WARFARIN; RIVOCOR
Current Illness: Atrial fibrillation; Hypertension arterial
Preexisting Conditions: Medical History/Concurrent Conditions: Pulmonary embolism (st. post pulmonary embolism)
Allergies:
Diagnostic Lab Data: Test Date: 20210218; Test Name: Covid-19 positive; Result Unstructured Data: Test Result:positive
CDC Split Type: CZPFIZER INC2021250168

Write-up: Pneumonia; COVID-19: positive; fell down; Weakness generalised; Unable to walk; This is a spontaneous report from a contactable Consumer or other non HCP downloaded from the regulatory authority-WEB CZ-CZSUKL-21001234 A 91-year-old male patient received the 1st dose of bnt162b2 (COMIRNATY, Lot # EL0725) at single dose on 09Feb2021 for COVID-19 immunisation. Medical history included ongoing arterial hypertension, st. post pulmonary embolism, ongoing atrial fibrillation. Concomitant medication included amiloride hydrochloride, hydrochlorothiazide (LORADUR), ramipril (TRITACE) at 1.25 mg, warfarin (manufacturer unknown) oral at 5 mg (1x za 24hodin) (as reported) for lung embolism, bisoprolol fumarate (RIVOCOR) At 5 mg. The patient experienced pneumonia and COVID-19 positive (serious as fatal, hospitalization, medically significant, life threatening) on 18Feb2021, weakness generalised (serious as hospitalization, disability, medically significant, life threatening) on 12Feb2021 with outcome of not recovered, fell down (serious as hospitalization) on 15Feb2021 with outcome of unknown, unable to walk on 12Feb2021 with outcome of unknown. The patient underwent lab tests and procedures which included COVID-19: positive on 18Feb2021. Course of events was as follows: after the 1st dose vaccination the patient experienced following adverse reaction: generalised weakness after the vaccination, lost his overall energy, started to walk badly, could not sit on bed by himself or to stand up. On 15Feb2021 afternoon the patient fell down and was transferred to the hospital. He was released home the same day, still not self-sufficient. On 18Feb2021 the patient was Covid-19 positive and hospitalised with pneumonia. On 19Feb2021 the patient died in the evening hours. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Unknown cause of death


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