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

This is VAERS ID 1434441

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Case Details

VAERS ID: 1434441 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 antibody test, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 9
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 respiratory failure (Person considered at risk); COPD (under 1.5L of O2 at home)
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer of prostate; COVID-19; Hip prosthesis insertion (right hip prosthesis); Hypertension arterial (high blood pressure); Radiotherapy; Silicosis
Diagnostic Lab Data: Test Date: 20210530; Test Name: Covid-19 serology; Result Unstructured Data: Test Result:IgM + IgG negative; Test Date: 20210530; Test Name: SARS-CoV-2 test; Test Result: Positive ; Comments: PCR test shows positive SARS CoV2 detection (SARS CoV2 RNA detected) Conclusion: profile compatible with a 20l / 501y variant
CDC Split Type: FRPFIZER INC2021752933

Write-up: Vaccination failure; serious covid; This is a spontaneous report from a contactable physician downloaded from the WEB FR-AFSSAPS-2021069690. An 82-year-old male patient received bnt162b2 (COMIRNATY), dose 2 via intramuscular, administered in Arm Left on 02Apr2021 (Lot Number: ET7205), dose 1 via an unspecified route of administration in Mar2021 (Batch/Lot number was not reported), both at single dose for COVID-19 immunisation. Medical history included COVID-19 from an unknown date and unknown if ongoing (as reported), chronic obstructive pulmonary disease (under 1.5L of O2 at home), silicosis, prostate cancer, radiotherapy (Mar2021), right hip prosthesis (2014) and high blood pressure/hypertension arterial. The patient was considered as at risk for chronic respiratory failure. The patient''s concomitant medications were not reported. On 29May2021 (day 57 of Dose 2), the patient experienced vaccination failure: serious COVID, putting on optiflow (in intensive care). The event was serious for hospitalization and fatal. IgM + IgG negative serology on 30May2021 despite two injections. The PCR test on 30May2021 showed positive SARS CoV2 detection (SARS CoV2 RNA detected), conclusion: profile compatible with a 20l / 501y variant (says English). The patient died on 07Jun2021. It was not reported if an autopsy was performed. NB: Accountability without prejudice to the elements of investigation which could be carried out within the framework of legal or amicable compensation procedures. Information on the batch number has been requested. ; Reported Cause(s) of Death: serious covid; Vaccination failure

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