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

This is VAERS ID 1173181



Case Details

VAERS ID: 1173181 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-01
Onset:2021-02-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT KNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Lower respiratory tract infection, Pneumonia, SARS-CoV-2 test, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   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:
Preexisting Conditions: Medical History/Concurrent Conditions: Chest infection; Dementia; Pneumonia
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:no-negative
CDC Split Type: GBPFIZER INC2021350114

Write-up: pneumonia; chest infection; lost strength and mobility; Sudden death; This is a spontaneous report from a contactable other healthcare professional. This is a report received from the regulatory authority. Regulatory authority report number GB-MHRA-WEBCOVID-202103291436232640, Safety Report Unique Identifier GB-MHRA-ADR 25045189. An 82-year-old male patient received first dose of bnt162b2 (COVID-19 MRNA VACCINE BIONTECH) unspecified route of administration on 01Feb2021 (batch/lot number not reported, expiration date not reported) at single dose for COVID-19 immunisation. Medical history included dementia, chest infection, pneumonia from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Patient was physically strong and well. Patient had not had symptoms associated with COVID-19. Patient was not enrolled in clinical trial. The patient experienced sudden death on 07Feb2021, pneumonia and chest infection on an unspecified date. The clinical course was reported as follows: Within days (redacted) lost strength and mobility. GP diagnosis of chest infection. Further GP visit diagnosed pneumonia. Died 6 days after vaccine. The patient underwent lab tests and procedures which included COVID-19 virus test: no-negative on unspecified date. Outcome of events pneumonia, chest infection and lost strength and mobility was unknown. The patient died on 07Feb2021. Cause of death was not reported. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Sudden death


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