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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1316394

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Case Details

VAERS ID: 1316394 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-24
Onset:2021-03-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2659 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: C-reactive protein, C-reactive protein increased, Chest X-ray, Death, Dyspnoea, General physical health deterioration, Oxygen saturation, Oxygen saturation decreased, Pneumonia, Pyrexia, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 12
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: 20210325; Test Name: Chest X-ray; Result Unstructured Data: Test Result:signs of pneumonia; Test Date: 20210325; Test Name: CRP; Result Unstructured Data: Test Result:240; Test Date: 20210325; Test Name: O2 saturation; Result Unstructured Data: Test Result:very low
CDC Split Type: BEPFIZER INC2021522157

Write-up: Death; Pneumonia; Oxygen saturation low; Difficulty breathing; General physical health deterioration; Fever; CRP increased; respiratory disorder; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is BE-FAMHP-DHH-N2021-90754. A 79-year-old male patient received the first dose of BNT162B2 (COMIRNATY, Batch/lot number ER2659) on 24Mar2021 at single dose for COVID-19 immunisation. Medical history was reported as no particular history. Concomitant medications were not reported. It was reported adverse drug reactions (ADR''s): respiratory disorder, difficulty breathing, general physical health deterioration, pneumonia, CRP increased, oxygen saturation low on 25Mar2021, death on 06Apr2021. It was reported fever starting 1 or 2 days after Covid vaccination, continuing for 2-3 days with signs of deteriorating general condition. Call from the attending physician who orders a chest x-ray at the hospital. Suggested diagnosis: pneumonia. Rapid worsening leading to death. Reporter''s comments: Treatment given in hospital: oxygen, antibiotics. Evolution of the ADR was death. Examinations included inflammatory syndrome (CRP: 240), Chest x-ray showing signs of pneumonia; very low O2 saturation. Outcome of respiratory disorder, difficulty breathing, general physical health deterioration, pneumonia, CRP increased, oxygen saturation low, fever was unknown, for death was fatal. An autopsy was unknow and the reported cause of death was unknown. No follow-up attempts are possible. No further information expected.; Reporter''s Comments: Treatment given in hospital: oxygen, antibiotics. Examinations - inflammatory syndrome (CRP: 240), Chest x-ray showing signs of pneumonia; very low O2 saturation. Fever starting 1 or 2 days after Covid vaccination, continuing for 2-3 days with signs of deteriorating general condition. Call from the attending physician who orders a chest x-ray at the hospital. Suggested diagnosis: pneumonia. Rapid worsening leading to death in a 79-year-old man with no particular history.; Reported Cause(s) of Death: death


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