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

This is VAERS ID 1113852



Case Details

VAERS ID: 1113852 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-01
Onset:2021-02-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Chills, Fatigue, Malaise, Myalgia, Pyrexia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart failure; Pulmonary hypertension
Allergies:
Diagnostic Lab Data: Test Date: 20210203; Test Name: pyrexia; Result Unstructured Data: Test Result:Fever: 38 to 40.5 degrees Celsius Centigrade; Test Date: 20210204; Test Name: SARS CoV 2 test; Test Result: Positive
CDC Split Type: NLPFIZER INC2021256546

Write-up: Myalgia; Chills; Pain in the joints; Corona test / positive three days after first vaccination; Not feeling well; Fatigue; Fever: 38 to 40.5 degrees Celsius; This is a spontaneous report from a contactable consumer downloaded from the Agency Regulatory Authority-WEB (NL-LRB-00461135). An 82-year-old male patient received the first dose of BNT162B2 (COMIRNATY), via an unspecified route of administration, on 01Feb2021 at single dose for COVID-19 immunisation. Relevant medical history included pulmonary hypertension and heart failure. The patient was receiving unspecified concomitant medications. On 02Feb2021, the patient was not feeling well, she had fatigue and fever: 38 to 40.5 degrees Celsius. On 04Feb2021, the patient developed myalgia, chills and pain in the joints. These events led to patient''s death in 2021. On 04Feb2021, SARS-COV-2 test was done and resulted positive. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Fatigue; Fever: 38 to 40.5 degrees Celsius; Myalgia; Chills; Pain in the joints; Covid-19; Not feeling well


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