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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1377606

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Case Details

VAERS ID: 1377606 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Arterial rupture, Coma, Multiple organ dysfunction syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 28
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:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021590610

Write-up: Multiorgan failure; Coma; Arterial rupture; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB DE-PEI-202100071816. A 78-year-old male patient received bnt162b2 (COMIRNATY, mRNA TOZINAMERAN), via an unspecified route of administration on 05Apr2021 as unknown, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 06Apr2021 the patient experienced Arterial rupture. On 08Apr2021 the patient experienced Coma. On 04May2021 the patient experienced Multiorgan failure. Patient died on 04May2021. The patient''s outcome was: fatal for Arterial rupture, fatal for Coma, fatal for Multiorgan failure. Relatedness of drug to reactions from Regulatory Authority was "Unclassifiable". Unknown if autopsy done. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Multiple organ failure; Arterial rupture; Coma

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