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

This is VAERS ID 1165308



Case Details

VAERS ID: 1165308 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-19
Onset:2021-03-16
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER0641 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 14
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:
Allergies:
Diagnostic Lab Data: Test Date: 20210312; Test Name: Covid-19 PCR test; Result Unstructured Data: Test Result:absence of SARS COV 2 in the sample; Test Date: 20210316; Test Name: Covid-19 PCR test; Result Unstructured Data: Test Result:weak positive, probable indicator of moderate vira; Comments: weak positive, probable indicator of moderate viral excretion
CDC Split Type: FRPFIZER INC2021342462

Write-up: Vaccination failure; COVID-19 pneumonia; This is a spontaneous report from a contactable consumer downloaded from the Agency Regulatory Authority-WEB FR-AFSSAPS-TO20211956. A 50-year-old male patient received second dose of bnt162b2 (COMIRNATY, solution for injection, lot: ER0641), intramuscular on 19Feb2021 as single dose for covid-19 immunisation. The patient received first dose of bnt162b2 (lot: EJ6788) on 26Jan2021 as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. PCR test on 12Mar2021 with absence of SARS COV 2 in the sample. On 16Mar2021, the patient had vaccination failure and COVID-19 pneumonia. PCR test on 16Mar2021 with weak positive, probable indicator of moderate viral excretion. The patient died in Mar2021 due to vaccination failure and COVID-19 pneumonia. It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: COVID-19 pneumonia; Vaccination failure


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