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

This is VAERS ID 1318095

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Case Details

VAERS ID: 1318095 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-01
Onset:2021-04-21
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PERMIXON; TEMERIT; LERCAN; KENZEN [CANDESARTAN CILEXETIL]; EUPANTOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Gastrooesophageal junction cancer metastatic (chemotherapy with XELODA); Hypertension arterial; Prostatic carcinoma
Allergies:
Diagnostic Lab Data: Test Date: 20210422; Test Name: O2; Result Unstructured Data: Test Result:40; Comments: L/min; Test Date: 20210422; Test Name: O2; Result Unstructured Data: Test Result:15; Comments: L/min; Test Date: 20210422; Test Name: O2; Result Unstructured Data: Test Result:30; Comments: L/min; Test Date: 20210422; Test Name: COVID diagnosis; Test Result: Positive
CDC Split Type: FRPFIZER INC2021521572

Write-up: Vaccination failure; COVID-19; This is a spontaneous report from a contactable pharmacist downloaded from the Regulatory Authority-WEB FR-AFSSAPS-LL20212462 with Safety Report Unique Identifier FR-AFSSAPS-2021047805. An 85-year-old male patient received bnt162b2 (COMIRNATY lot/batch number and expiration date not reported) intramuscular on Feb2021 as 1st dose, single and on Mar2021 as 2nd dose, single for COVID-19 immunisation. Medical history included gastrooesophageal junction cancer metastatic (chemotherapy with XELODA), prostatic carcinoma and hypertension arterial. Concomitant medications included serenoa repens extract (PERMIXON), nebivolol hydrochloride (TEMERIT), lercanidipine hydrochloride (LERCAN), candesartan cilexetil (KENZEN [CANDESARTAN CILEXETIL]) and pantoprazole sodium sesquihydrate (EUPANTOL). The patient experienced vaccination failure and COVID-19 on 21Apr2021. On 21Apr2021: fall at home, inability to get up then disturbance of consciousness. Supported by the Emergency and Resuscitation Service then in the emergency room of the Hospital. On 22Apr2021: COVID diagnosis with unfavorable prognosis, maximum care in room but rejected for resuscitation. COVID disease management with oxygen therapy, roactemra 700 mg, levofloxacin 750 mg / 24h, dexamethaosone 6mg / 24h, cefotaxime 3g / 24h. On 22Apr2021: patient who desaturated under O2 15 L / min. O2 increased to 30 L / min then to 40 L / min. On 23Apr2021: death of the patient due to the events. 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: Vaccination failure; COVID-19


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