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

This is VAERS ID 1114063



Case Details

VAERS ID: 1114063 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-19
Onset:2021-02-19
   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 EJ6788 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Death, Dyspepsia, Feeling hot, Heart rate, Malaise, Oxygen saturation, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XATRAL; PANTOPRAZOLE; FORLAX; LERCAN; LUMIGAN; CARTEOLOL HYDROCHLORIDE; DOLIPRANE; APIXABAN; LEVETIRACETAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Cerebrovascular accident; Epilepsy; Glaucoma; Hypertension arterial; Mixed dementia; Senile macular degeneration; Surdity
Allergies:
Diagnostic Lab Data: Test Date: 20210220; Test Name: blood pressure; Result Unstructured Data: Test Result:13/7; Comments: normal; Test Date: 20210220; Test Name: Body temperature; Result Unstructured Data: Test Result:37; Comments: normal; Test Date: 20210220; Test Name: beats per minute; Result Unstructured Data: Test Result:108; Comments: normal; Test Date: 20210220; Test Name: oxygen saturation; Test Result: 93 %; Comments: normal
CDC Split Type: FRPFIZER INC2021272356

Write-up: vomiting (low volume); feeling unwell; Found dead (cause undetermined); gastric burning; hot sensation without fever; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority FR-AFSSAPS-TO20211123. A 91-year-old male patient received the second dose of BNT162B2 (COMIRNATY), intramuscularly, administered in Arm Left at single dose on 19Feb2021 (at age of 91-year-old) (Lot Number: EJ6788) for COVID-19 immunization. Medical history included cerebrovascular accident, surdity, epilepsy, mixed dementia, atrial fibrillation, Hypertension arterial, glaucoma, senile macular degeneration. Concomitant medications included alfuzosin hydrochloride (XATRAL LP, 10 mg prolong release tablet), pantoprazole, macrogol 4000 (FORLAX 10 g, powder for oral solution in sachet-dose), lercanidipine hydrochloride (LERCAN 20 mg film-coated tablet), bimatoprost (LUMIGAN); carteolol hydrochloride,paracetamol (DOLIPRANE), apixaban, and levetiracetam. On 19Feb2021, after vaccination, the patient developed a gastric burning and hot sensation without fever. On 20Feb2021 at 3.30 A.M., the patient experienced vomiting (low volume). Vital signs were normal (blood pressure 13/7, oxygen saturation 93%, beats per minute 108 and temperature 37 (units not provided)). On 20Feb2021, upon waking-up, the patient was feeling unwell, had breakfast in common room and then returned to bed. On 20Feb2021 at 10 A.M., the patient was found dead in his bed (unknown cause). The outcome of events ''gastric burning'' , ''hot sensation without fever'' and vomiting was not resolved, of the event ''feeling unwell'' was unknown. The patient died on 20Feb2021. An autopsy was not performed. No follow-up attempts are possible.No further information is expected.; Reported Cause(s) of Death: Unknown cause of death


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