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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1112868



Case Details

VAERS ID: 1112868 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-18
Onset:2021-01-29
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Haemorrhagic stroke, Nervous system disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KEMADRIN; VITAMIN D NOS; HALDOL; LORMETAZEPAM; BEFACT [CYANOCOBALAMIN;PYRIDOXINE HYDROCHLORIDE;RIBOFLAVIN;THIAMINE MONONITRATE]; BISOPROLOL; TAMSULOSIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Benign prostatic hyperplasia; Mitral insufficiency (mild aortic and mitral insufficiency); Paranoid schizophrenia; Comments:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEPFIZER INC2021250330

Write-up: Nervous system disorder; Hemorrhagic stroke; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Authority-WEB. The Regulatory Authority report number is BE-FAMHP-DHH-N2021-79017. This report originated from the Regulatory Authority. A 77-year-old male patient received the first dose of bnt162b2 (COMIRNATY, lot number: EM0477), via an unspecified route of administration on 18Jan2021 at single dose for Covid-19 immunization. Medical history included paranoid schizophrenia, benign prostatic hyperplasia, and mild aortic and mitral insufficiency. Concomitant medications included procyclidine hydrochloride (KEMADRIN), vitamin D, haloperidol (HALDOL), lormetazepam, cyanocobalamin, pyridoxine hydrochloride, riboflavin, thiamine mononitrate (BEFACT), bisoprolol, and tamsulosin; all taken from an unspecified date for an unspecified indication. Nutritional supplement included Easy-Transil. The patient experienced nervous system disorder and hemorrhagic stroke, both on 29Jan2021 with fatal outcome. There was no treatment received for the adverse events. The patient died on 01Feb2021. It was unknown if an autopsy was performed. Events were assessed by FAMHP as unclassifiable. Reporter comment: Patient was of a thin corpulence. He had a correct general condition before and after vaccination. On 29Jan2021, neurological problems appeared: agitation, mutism, swallowing disorders, falls,..linked with a cerebral haemorrhage. Follow-up attempts are not needed. No further information is expected.; Reported Cause(s) of Death: Nervous system disorder; Hemorrhagic stroke


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