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

This is VAERS ID 1467558

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Case Details

VAERS ID: 1467558 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-27
Onset:2021-05-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8889 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Fatigue, Malaise, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-31
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Back pain; Bursitis; Diabetes; Lung disease; Obesity; Smoker
Allergies:
Diagnostic Lab Data: Test Name: tested; Result Unstructured Data: Test Result:was not diagnosed with SARS or other coronavirus
CDC Split Type: BEPFIZER INC2021795171

Write-up: Died; Feeling unwell; Fatigue; Fever; This is a spontaneous report from a contactable consumer, downloaded from the Regulatory Authority-WEB, Regulatory Authority Number: BE-FAMHP-DHH-N2021-98095. A 67-years-old male patient received bnt162b2 (COMIRNATY), dose 2 via an unspecified route of administration on 27May2021 (Batch/Lot Number: FC8889) as DOSE 2, SINGLE for COVID-19 immunisation. Medical history included diabetes, bursitis hip, smoker, obesity, and back pain for which pain treatment were indicated to be started. Hospitalization/investigations (scans, etc.) were reportedly in progress because of back problems over the last few months. It was also reported that the patient did not go through COVID-19 infection, but had an unidentified, rare, severe lung disease once after a trip (in 2011? 2016? or earlier than that; not sure of the date/year). The patient was not diagnosed with SARS or other coronavirus, it was tested for at the time. Upon starting COVID, the patient''s family doctor informed the reporting consumer that he saw similarities to the reporter''s father''s illness years ago. The patient previously received the first dose of bnt162b2 (COMIRNATY) on an unknown date for COVID-19 immunisation and felt quite ill, the reporter thinks the patient also had fever and was short of breath for a few days. The patient''s concomitant medications were not reported. The patient experienced fever, malaise, and fatigue on 28May2021. Treatment for the events was reported as unknown. The patient died on 31May2021. It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: Treatment - Unknown. Evolution of the ADR - Deceased.Did not go through Covid19 infection. Had an unidentified, rare, severe lung disease once after a trip in (2011? 2016? Or earlier than that? Am not sure). Was not diagnosed as Sars or other coronavirus, it was tested for at the time I believe). Upon starting Covid, his family doctor informed me that he saw similarities to my father''s illness years ago. Reaction after first dose? Yes, felt quite ill. I think fever and short of breath, few days. Health condition before 2nd dose: he was not sick, but had diabetes, inflamed bursa hip, back pain, for which pain treatment would be started soon. Hospitalization? Investigations (scans, etc.) were in progress because of back problems over the last few months.; Reported Cause(s) of Death: Fatigue; Fever; Feeling unwell


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