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

This is VAERS ID 1165301



Case Details

VAERS ID: 1165301 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6950 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Brain hypoxia, Coma, Hemiplegia, Lung disorder, Pneumonia, Pyrexia, Respiratory distress, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 4
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: Leukoencephalopathy; Pulmonary embolism; Stroke; Vascular dementia
Allergies:
Diagnostic Lab Data: Test Date: 20210223; Test Name: COVID-19 test; Result Unstructured Data: Test Result:unknown
CDC Split Type: FRPFIZER INC2021342434

Write-up: Distress respiratory; Pneumopathy; coma; left hemiplegia; cerebral hypoxemia; bibasal pneumonia; Fever; This is a spontaneous report from a contactable physician from the Agency Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-PC20210598. A 93 year old male patient received bnt162b2 (COMIRNATY), dose 2 intramuscular on 18Feb2021 (Lot Number: EM6950) as single dose for COVID-19 immunization. Medical history included vascular dementia, stroke 2005, marked leukopathy and pulmonary embolism 2016. The patient''s concomitant medications were unspecified. The patient previously had first dose of COMIRNATY for COVID-19 immunization. On 19Feb2021 24 hours after the second injection, the patient experienced fever and bibasal pneumonia. The patient had antibiotic treatment. On 23Feb2021, the patient experienced coma, left hemiplegia, respiratory distress. Per radiological, there was a disappearance of the pneumopathy, persistent coma probably due to cerebral hypoxemia). The patient died on 23Feb2021 due to the events. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: Distress respiratory; Fever; Pneumopathy; bibasal pneumonia; coma; left hemiplegia; cerebral hypoxemia


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