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

This is VAERS ID 1428233

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Case Details

VAERS ID: 1428233 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood creatinine, Blood potassium, Blood urea, Body temperature, C-reactive protein, Drug ineffective, Fibrin D dimer, Haemoglobin, Lymphopenia, Mean cell volume, Oxygen saturation, SARS-CoV-2 test, Suspected COVID-19
SMQs:, Haematopoietic leukopenia (narrow), Lack of efficacy/effect (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Deep vein thrombosis; Exposure to COVID-19; Pulmonary embolism
Diagnostic Lab Data: Test Date: 202102; Test Name: creatinine; Result Unstructured Data: Test Result:156 umol/l; Test Date: 202102; Test Name: blood potassium; Result Unstructured Data: Test Result:5.22 mmol/L; Test Date: 202102; Test Name: urea; Result Unstructured Data: Test Result:13.87 mmol/L; Test Date: 202102; Test Name: body temperature; Result Unstructured Data: Test Result:feverish; Test Date: 202102; Test Name: C-reactive protein; Result Unstructured Data: Test Result:93.9 mg/l; Test Date: 202102; Test Name: fibrin D dimer; Result Unstructured Data: Test Result:2070 ng/ml; Test Date: 202102; Test Name: hemoglobin; Result Unstructured Data: Test Result:10.1 g/dl; Test Date: 202102; Test Name: lymphopenia; Result Unstructured Data: Test Result:460 /mm3; Test Date: 202102; Test Name: MCV; Result Unstructured Data: Test Result:82.7; Test Date: 202102; Test Name: oxygen saturation; Test Result: 93 %; Comments: under 1 liter of oxygen; Test Date: 202102; Test Name: sars-cov-2 test; Test Result: Negative
CDC Split Type: FRPFIZER INC2021689043

Write-up: COVID-19 aggravated; COVID-19 aggravated; This is a spontaneous report from a contactable pharmacist downloaded from a regulatory authority-WEB FR-AFSSAPS-CN20211213, Safety Report Unique Identifier FR-AFSSAPS-202103671. An 89-year-old male patient received BNT162b2 (COMIRNATY), dose 1 intramuscularly on 31Jan2021 (Batch/Lot Number: Unknown) as single dose for COVID-19 immunisation. Medical history included deep vein thrombosis and pulmonary embolism from an unknown date and unknown if ongoing. The patient received medication assistance in the morning, and could walk without technical assistance. Allergic history were not specified. The patient had no history of COVID-19. The patient lived with a partner at home and was in contact with his partner: PCR covid positive partner on 13Feb2021. The patient was then negative (PCR test). Concomitant medication(s) included furosemide (LASILIX FAIBLE) taken for an unspecified indication from 01Jan2018 to an unspecified stop date; acetylsalicylate lysine (KARDEGIC) taken for an unspecified indication from 01Jan2018 to an unspecified stop date; nicorandil (IKOREL) taken for an unspecified indication from 01Jan2018 to an unspecified stop date; atorvastatin calcium (TAHOR) taken for product used for unknown indication from 01Jan2018 to an unspecified stop date. No recent changes in processing. No information on immediate post-vaccination effects. The patient was referred by the fire brigade for dyspnea which had been evolving for 48 hours, feverish, with chills, with chest tightness, no real chest pain. There was no anosmia, no ageusia, no headache, no transit disorders. Note that the patient was in contact with his partner: PCR covid positive partner on 13Feb2021. The patient was then negative. On arrival in the department, the patient was feverish, his hemodynamics were stable. The saturation was 93% under 1 liter of oxygen. The sounds of the heart were regular, with no obvious murmurs. There was no sign of cardiac decompensation, no sign of deep vein thrombosis. The patient was eupneic at rest under 1 liter of oxygen, the vesicular murmur was bilateral and symmetrical without added noise. He had rhinitis. The abdomen was flexible, compressible, painless. The patient was disoriented but coherent, there was no sign of neurological localization. The biology carried out found the following biological anomalies: a biological inflammatory syndrome with a CRP at 93.9 mg / L without associated hyperleukocytosis; lymphopenia at 460 / mm3; an increase in Ddimers to 2070ng / mL; normocytic anemia with hemoglobin at 10.1g / dL, MCV at 82.7fL; an acute on chronic renal failure with a creatinine level of 156umol / L of functional appearance with a urea at 13.87mmol / L, with a usual creatinine level of around 110umol / L, hyperkalaemia at 5.22mmol / L. Reinforced contact and droplet isolation was introduced. Corticosteroid therapy with Dexamethasone 6 mg was started. An anticoagulation by heparin calcium was started, not being able to eliminate an embolic process. The anticoagulation was relayed in the service by tinzaparin INNOHEP. The patient deteriorated suddenly during the night of 21Feb2021 to 22Feb2021, with an increase in oxygen requirements of up to 15 liters and fecaloid vomiting, the patient''s abdomen being painless, flexible, compressible and transit preserved. Death on 23Feb2021 at 8.15 a.m. No autopsy performed. The reported event was "COVID-19 aggravated", onset date 20Feb2021, with fatal outcome. Existence of an acute pathology or a specific complaint in the days preceding death or the days preceding vaccination was unspecified. No existence of a chronic pathology in the process of decompensation or aggravation.; Reported Cause(s) of Death: COVID-19 aggravated

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