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

This is VAERS ID 1427626

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Case Details

VAERS ID: 1427626 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-13
Onset:2021-05-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW8904 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Circulatory collapse, Computerised tomogram, Nausea, Peripheral vascular disorder, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Chronic kidney disease; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Chills; Cough; Fever
Allergies:
Diagnostic Lab Data: Test Name: CT; Result Unstructured Data: Test Result:unknown result
CDC Split Type: DEPFIZER INC2021688003

Write-up: stroke; Nausea; Circulatory disorder peripheral; Vomiting; circulatory collapse; This is a spontaneous report from a non-contactable consumer downloaded from a regulatory authority-WEB, regulatory authority number DE-PEI-CADR2021088025, Sender''s (Case) Safety Report Unique Identifier DE-PEI-202100080890. This is a first of two reports for the second dose. A 85 Years old male patient received second dose BNT162B2 (COMIRNATY, lot number EW8904), via an unspecified route of administration on 13-APR-2021 at single dose for COVID-19 immunisation. The medical history included ongoing Hypertension, ongoing Chronic kidney disease and high fever, chills, cough. The concomitant medications were not reported. The Historical Vaccine was COMIRNATY (Strength: 0.3 ml) on 23FEB2021 for Prophylactic vaccination and experienced Pneumonia. On 01May2021 the patient experienced Vomiting, Nausea, Circulatory disorder peripheral, stroke, circulatory collapse. The patient was hospitalized due to all of the events in 2021. The patient underwent lab tests and procedures, which included CT : unknown result. The patient died on an unknown date. It''s unknown if an autopsy was performed. The cause of death was stroke. The outcome of the event stroke was fatal, the others was not recovered. No follow-up attempts possible. No further information expected.; Sender''s Comments: Linked Report(s) : DE-PFIZER INC-2021696465 same patient and drug, different dose/event; Reported Cause(s) of Death: stroke


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