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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1432413

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Case Details

VAERS ID: 1432413 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-20
Onset:2021-06-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3661 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Computerised tomogram, Near drowning
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ascites (the patient was hospitalized from 27May2021 to 02Jun2021); Gastric cancer; Hospitalization; Hypertension; Pleural effusion (the patient was hospitalized from 27May2021 to 02Jun2021); Surgery
Allergies:
Diagnostic Lab Data: Test Date: 20210620; Test Name: Body temperature; Result Unstructured Data: Test Result:35.6 Centigrade; Comments: before vaccination; Test Date: 20210620; Test Name: Postmortem CT; Result Unstructured Data: Test Result:findings of near drowning only; Comments: Findings of near drowning in the lung and paranasal sinus only. There was no abnormality other than known finding(s) in the head and thoracoabdominal part.
CDC Split Type: JPPFIZER INC2021749331

Write-up: Near drowning; This is a spontaneous report from a contactable physician received via COVID-19 Adverse Event Self-Reporting Solution (COVAES) and from the regulatory authority. Regulatory authority report number is v21115449. The patient was a 91-year-old male. Body temperature before vaccination was 35.6 degrees centigrade. The patient''s family history was unknown. Medical history of pleural effusion and ascites, for which the patient was hospitalized from 27May2021 to 02Jun2021. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient received hypotensive medications within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient had no allergies to medications, food, or other products. Other medical history included the status after the surgery for gastric cancer, and hypertension. On 20Jun2021 at 10:45 (the day of vaccination), the patient received the first single dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number FC3661, Expiration date 30Sep2021) intramuscular at the age of 91-year-old in the left arm for COVID-19 immunization at other facility. On 20Jun2021 at 20:28 (9 hours and 43 minutes after the vaccination), the patient experienced near drowning. The event resulted in death (The cause of death was near drowning). The patient did not receive any treatment for the event. 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: At 19:30, the patient was bathing alone and did not come out. At 20:28, family member went to found out that the patient sank in the bathtub. Emergency medical service performed cardiopulmonary resuscitation and the patient was transferred to a hospital. However, at 21:08, the patient was confirmed to be dead. Postmortem CT (on 20Jun2021) revealed findings of near drowning in the lung and paranasal sinus only. There was no abnormality other than known finding(s) in the head and thoracoabdominal part. The reporting physician classified the event as serious (death) and assessed that the causality between the event and BNT162b2 as unassessable. There was no other possible cause of the event such as any other diseases. The outcome of event was fatal. The reporting physician commented as follows: On 02Jun2021, at the time when the patient was discharged from the hospital, activities of daily living (ADL) including eating meals and walking were more or less maintained. Causality between near drowning and the vaccination was unknown.; Reporter''s Comments: On 02Jun2021, at the time when the patient was discharged from the hospital, activities of daily living (ADL) including eating meals and walking were more or less maintained. Causality between near drowning and the vaccination was unknown.; Reported Cause(s) of Death: Near drowning


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