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

This is VAERS ID 1112893



Case Details

VAERS ID: 1112893 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-06
Onset:2021-01-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6797 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021266949

Write-up: Pulmonary failure; This is a spontaneous report downloaded from the European Medicines Agency (EMA) EudraVigilance-WEB [regulatory authority number DE-PEI-CADR2021015336]. A 61-years-old male patient received bnt162b2 (COMIRNATY,Batch/Lot Number: EJ6797), intravenous on 06Jan2021 at 0.3 mL, single for COVID-19 immunization. Medical history included ongoing hypertension. The patient''s concomitant medications were not reported. The patient experienced pulmonary failure on 15Jan2021.The patient died on 02Feb2021. It was not reported if an autopsy was performed. Outcome of event was fatal. Sender Comment: mild hypertension / mild symptoms one day after vaccination, increasing deterioration within a week, hospitalization in the intensive care unit, lung failure. According to regulatory authority there is an Inconsistent causal association to immunization for the event Pulmonary failure. No follow-up attempts are possible. No further information is expected.


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