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

This is VAERS ID 1438809

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Case Details

VAERS ID: 1438809 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-13
Onset:2021-05-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood test, Cardiac arrest, Chills, Coma, Decreased appetite, Hypersomnia, Pain, Pneumonia, SARS-CoV-2 test, Sepsis, Somnolence, Thirst, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 17
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: BISOPROLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart rate abnormal; Pneumonia
Allergies:
Diagnostic Lab Data: Test Date: 20210529; Test Name: bloodstream; Result Unstructured Data: Test Result:Bacteria staphylococcus found; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test; Test Date: 20210526; Test Name: x-rays; Result Unstructured Data: Test Result:no causes found
CDC Split Type: GBPFIZER INC2021747242

Write-up: pneumonia; little brain activity lapsed into a coma; Heart stopped; drowsiness; Sepsis; extended sleeping period; rigor; pain in upper body; Loss of appetite; raging thirst; Loss of bodily strength unable to sit up or stand/problems with movement sitting up and standing; This is a spontaneous report from a contactable consumer received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106202125561590-QM3SC. A 74-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number: unknown), via an unspecified route of administration on 13May2021 as DOSE 2, SINGLE for COVID-19 immunisation. Medical history included pneumonia and heart rate abnormal. Nothing for immune response. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Concomitant medication included bisoprolol taken for heart rate abnormal from an unspecified start date to 05Jun2021. The patient previously took the first dose of bnt162b2 for COVID-19 immunisation. On 19May2021, the patient experienced drowsiness, pneumonia, sepsis, extended sleeping period, rigor, pain in upper body, loss of appetite, raging thirst, loss of bodily strength unable to sit up or stand/problems with movement sitting up and standing. On 01Jun2021, the patient experienced heart stopped and little brain activity lapsed into a coma. The patient was hospitalized for pneumonia from 29May2021. The patient underwent lab tests and procedures which included blood test where bacteria staphylococcus found on 29May2021, COVID-19 virus test was no - negative COVID-19 test on an unspecified date, and x-ray with no causes found on 26May2021. Therapeutic measures were taken as a result of little brain activity lapsed into a coma and included life support and heart stopped and included resuscitation. The patient died on 05Jun2021. It was not reported if an autopsy was performed. The clinical course was reported as follows: Six days after 2nd vaccine, Drowsiness followed by extended sleeping period, rigor, pain in upper body, Loss of appetite, raging thirst, Loss of bodily strength unable to sit up or stand. Checked over in hospital with x-rays no causes found sent home 26May. Continued problems with movement sitting up and standing. Readmitted to hospital 29May suspected pneumonia. Bacteria found in bloodstream staphylococcus. 01Jun Transferred to different hospital. No proper contact with hospital. Didn''t know where he was. Mobile unanswered. Found in ICU. Heart stopped had to be resuscitated little brain activity lapsed into a coma. No contact with hospital for 3 days. Finally life support turned off on 05Jun. Patient has not tested positive for COVID-19 since having the vaccine. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: extended sleeping period; rigor; pain in upper body; drowsiness; pneumonia; sepsis; loss of appetite; raging thirst; Loss of bodily strength unable to sit up or stand/problems with movement sitting up and standing; Heart stopped; little brain activit


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