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

This is VAERS ID 1437156

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Case Details

VAERS ID: 1437156 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-05-26
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Pneumonia, Thrombosis
SMQs:, Lack of efficacy/effect (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-22
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: BRPFIZER INC2021766809

Write-up: he developed covid-19 after taking the Pfizer vaccine; he developed covid-19 after taking the Pfizer vaccine; thrombosis; pneumonia; This is a spontaneous report from a contactable other health care professional (unknown relationship with patient) received through Agency. A 66-year-old male patient received BNT162B2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date (at age of 66 years old) as single dose for COVID-19 immunisation. Medical history included: diabetes. The patient''s concomitant medications were not reported. Prior to vaccination, the patient was not diagnosed with COVID-19. Patient developed COVID-19 on 26May2021 after taking the Pfizer vaccine (date not informed). The patient was admitted to the ICU on 26May2021 but was not intubated. After 10 days he was recovered but he remained in the ICU because he had thrombosis and then he had pneumonia caused by a hospital bacterium. He was intubated, needed hemodialysis and died on 22Jun21. Cause of death was pneumonia. Treatment received for the adverse event (Anticoagulant, antibiotics). Physician office visit for all events. The patient died on 22Jun2021. An autopsy was not performed. The outcome of the events developed COVID-19 was recovered on 05Jun2021, thrombosis was unknown. information on the lot/batch number has been requested.; Sender''s Comments: The information provided is very limited and does not allow for a complete medical assessment. Based on available information a contributory role of BNT162B2 to the reported events cannot be totally Additional information including date of vaccination, events onset dates, concomitant medications and their indications, concurrent medical conditions, complete medical history, diagnostic test results, is needed to better assess this report. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia


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