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

This is VAERS ID 1114008



Case Details

VAERS ID: 1114008 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-14
Onset:2021-01-14
   Days after vaccination:0
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: Altered state of consciousness, Cerebral infarction, Hemiparesis, Incorrect route of product administration
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Drug abuse and dependence (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Arrhythmia; Atrial fibrillation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021266957

Write-up: Masive middle cerebral artery infarct; Consciousness disturbed; severe left hemiparesis; COMIRNATY subcutaneous; This is a spontaneous report from a non-contactable consumer downloaded from the Regulatory Authority, regulatory authority number DE-PEI-CADR2021015226. An 88-year-old male patient received BNT162B2 (COMIRNATY, Solution for injection), subcutaneously at an unspecified age on 14Jan2021 (lot number: EJ6797, expiration date unknown) at single dose for covid-19 immunisation. Medical history included atrial fibrillation and arrhythmia, both ongoing. The patient''s concomitant medications were not reported. The patient previously took rivaroxaban from 12Jan2001 to 14Jan2021 for anticoagulation drug level increased. On 24Jan2021 the patient experienced masive middle cerebral artery infarct, consciousness disturbed, severe left hemiparesis. The outcome of event masive middle cerebral artery infarct was fatal. The patient died on 04Feb2021. The outcome of the other events was unknown. It was not reported if an autopsy was performed. Sender Comment: Absolute arrhythmia in atrial fibrillation. Oral anticoagulation with rivaroxaban from 12Jan2021 to 14Jan2021 paused / acute media infarction on the right with impaired consciousness and severe hemiparesis on the left. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Masive middle cerebral artery infarct


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