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

This is VAERS ID 1439099

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Case Details

VAERS ID: 1439099 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-14
Onset:2021-05-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER7449 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cyanosis, Death, Incontinence, Malaise, Myalgia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE BESILATE; BLOPRESS
Current Illness: Hyperlipidaemia; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210514; Test Name: body temperature; Result Unstructured Data: Test Result:36.1 Centigrade; Comments: Before vaccination
CDC Split Type: JPPFIZER INC2021704295

Write-up: unknown cause of death; cyanosis condition; incontinence; Vaccination site pain; General malaise; Myalgia; This is a spontaneous report from a contactable physician received from the Regulatory Authority. The regulatory authority report number is v21114096. A 47-year and 2-month-old male patient received the second dose of BNT162B2 (COMIRNATY; Lot Number: ER7449; Expiration Date: 30Jun2021), via an unspecified route of administration, on 14May2021 at 14:30 (at the age of 47-years-old) as a single dose for COVID-19 immunisation. Medical history included ongoing hypertension and ongoing hyperlipidaemia. Concomitant medications included amlodipine besilate (MANUFACTURER UNKNOWN) taken for hypertension from an unspecified date and ongoing and candesartan cilexetil (BLOPRESS) taken for hyperlipidaemia from an unspecified date and ongoing. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations, and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). The patient previously received the first dose of BNT162B2 (COMIRNATY) in 2021 for COVID-19 immunisation. The patient experienced unknown cause of death on 11Jun2021 at 08:30 (27 days and 18 hours after the vaccination), which was reported as fatal. The patient also experienced vaccination site pain, general malaise, and myalgia on 14May2021. The patient also experienced cyanosis condition and incontinence on 11Jun2021 at 08:30. The clinical course was reported as follows: The body temperature before vaccination was 36.1 degrees Centigrade on 14May2021. From 14May2021 (the day of vaccination) to 16May2021 (2 days after vaccination), the patient experienced vaccination site pain, general malaise, and myalgia (all symptoms were mild). On 11Jun2021, at 08:30 (27 days and 18 hours after vaccination), the patient stayed at his room in his working place from the previous day. In the morning, a staff member found the patient collapsed in the room. The patient was in cyanosis condition, and he had incontinence. No postmortem rigidity was observed. On the same day, from 08:38 (27 days, 18 hours, and 8 minutes after vaccination) to 09:46 (27 days, 19 hours, and 16 minutes after vaccination), the tracheal intubation was performed, and cardiac massage was performed; however, cardiopulmonary resuscitation was not confirmed. On the same day, at 09:46 (27 days, 19 hours, and 16 minutes after vaccination), the patient was confirmed to die. The obvious cause of death was unknown. The clinical outcome of unknown cause of death was fatal and of vaccination site pain, general malaise, myalgia, cyanosis condition, and incontinence was unknown. The patient died on 11Jun2021. The cause of death was reported as unknown. It was not reported if an autopsy was performed. The reporting physician assessed that the causality between the event and BNT162B2 as unassessable. Other possible causes of the event, such as any other diseases, were as follows: The following information was confirmed by his wife: The patient had medical histories of hypertension and hyperlipidaemia, for which he was orally taking amlodipine besilate and candesartan cilexetil. There were no other possible causes. The reporting physician commented as follows: The vaccination was performed as a healthcare professional. At the follow up after the vaccination, no serious side reactions were observed. It was considered that the causality between the event and BNT162B2 vaccination was very unlikely. However, since no detailed information was obtained, it was considered that further consideration was extremely difficult.; Reported Cause(s) of Death: unknown cause of death


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