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

This is VAERS ID 1151774

Case Details

VAERS ID: 1151774 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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: 2021-03-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Lung cancer
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021317258

Write-up: Respiratory failure; This is a spontaneous report received from a non-contactable physician downloaded from the regulatory authority-WEB. The regulatory authority report number is DE-PEI-PEI2021003607. A 66-year-old male patient received first dose of bnt162b2 (COMIRNATY), via intramuscular on 17Mar2021 (Batch/Lot Number: Unknown) as single dose for covid-19 immunisation. Medical history included ongoing palliative situation with lung cancer (CA). The patient''s concomitant medications were not reported. On the same day after vaccination the patient developed respiratory insufficiency, lasting for unknown. The patient died on 17Mar2021. Death cause was reported as respiratory failure. It was not reported if an autopsy was performed. Relatedness of drug to event assessed by PEI as indeterminate. No Follow-Up attempts are possible, information about batch number cannot be obtained.; Reporter''s Comments; Reported Cause(s) of Death: Respiratory failure

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