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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1404780



Case Details

VAERS ID: 1404780 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaemia
SMQs:, Haematopoietic erythropenia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC2021636370

Write-up: severe Anaemia; This is a spontaneous report from a contactable pharmacist via a Pfizer sales representative. A 90-year-old male patient received bnt162b2 (COMIRNATY, lot number and expiry date unknown), via an unspecified route of administration on 24May2021 as an unknown dose number, as a single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 01Jun2021, the patient was hospitalized for severe anaemia. The event was found after using the product. The outcome of the event was unknown. Information on the lot/batch number has been requested.


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