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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1419453

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Case Details

VAERS ID: 1419453 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY5420 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Pneumonia, Pneumothorax, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE; AMBROXOL; LANSOPRAZOLE; QUETIAPINE; ENALAPRIL; CARBOCISTEINE; MIYA BM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebral haemorrhage; Dementia; Hypertension
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: CT; Result Unstructured Data: Test Result:bilateral pneumonia, right pneumothorax
CDC Split Type: JPPFIZER INC2021710915

Write-up: Acute pneumonia/ bilateral pneumonia; Right pneumothorax; Vomiting; This is a spontaneous report from a contactable physician received via COVID-19 Adverse Event Self-Reporting Solution (COVAES). The 76-year-old male patient received the first single dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number EY5420, Expiration date 31Aug2021) intramuscular on 02Jun2021 at 14:30 at the age of 76-year-old (the day of vaccination) in the left arm for COVID-19 immunization. It was unknown if the patient had allergies to medications, food, or other products. Medical history included hypertension, dementia, and post cerebral haemorrhage. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient received amlodipine; ambroxol; lansoprazole; quetiapine; enalapril; carbocisteine; clostridium butyricum within 2 weeks of vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 03Jun2021 at 21:00 (1 days 6 hours and 30 minutes after the vaccination), the patient experienced acute pneumonia, right pneumothorax, and vomiting. The event acute pneumonia resulted in death. The outcome of the event acute pneumonia was fatal with treatment including antibiotics. The outcome of the other events was unknown. On 04Jun2021, the patient died from acute pneumonia. Cause of death was acute pneumonia. An autopsy was not performed. Since the vaccination, the patient has not been tested for COVID-19. The course of the event was as follows: On the nighttime of the following day of the vaccination (03Jun2021), the patient vomited. In addition, bilateral pneumonia and right pneumothorax were diagnosed 2 days after the vaccination (as reported) based on the CT performed. Antibiotic administration was performed, however, the patient died 2 days after the vaccination(04Jun2021).; Sender''s Comments: The events pneumonia and pneumothorax were considered intercurrent conditions in this elderly patient and assessed to be unrelated to suspect product BNT162b2 (COMIRNATY, Solution for injection, Lot number EY5420, Expiration date 31Aug2021).; Reported Cause(s) of Death: Acute pneumonia


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