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

This is VAERS ID 1589040

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Case Details

VAERS ID: 1589040 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-04
Onset:2021-08-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Heart rate, Pyrexia, Respiratory rate
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DOLIPRANE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic respiratory failure; End stage COPD (after smoking); Exeresis; Fibrosis lung; Hypertension pulmonary; Ischemic heart disease
Allergies:
Diagnostic Lab Data: Test Date: 20210804; Test Name: pulse; Result Unstructured Data: Test Result:quick, fast, regular; Test Date: 20210804; Test Name: fever; Result Unstructured Data: Test Result:37; Test Date: 20210804; Test Name: fever; Result Unstructured Data: Test Result:37.8; Test Date: 20210804; Test Name: respiratory rate; Result Unstructured Data: Test Result:20; Test Date: 20210804; Test Name: respiratory rate; Result Unstructured Data: Test Result:32
CDC Split Type: FRPFIZER INC202101045341

Write-up: Aggravation of existing disorder; This is a spontaneous report from a contactable pharmacist downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-PB20215307. An 81-year-old male patient received the second dose of BNT162B2 (COMIRNATY, Lot number unknown) Intramuscular at single dose for COVID-19 immunisation on 04Aug2021. Relevant history included end stage COPD after smoking, ischemic heart disease, Multifactorial terminal respiratory failure (under O2 at home between 4 and 6l minutes), hypertension pulmonary, and fibrosis lung since May 2021, and post-lobectomy restriction. Relevant concomitant drug included paracetamol (DOLIPRANE) for pain. On 04Aug2021, in the morning, the patient was less well, more asthenic, more sleepy, but conscious, communicating, no sign of distress respiratory, respiratory rate 20. No sign of concern. The 2nd dose of Pfizer vaccine done at 11:45 am on 04Aug2021. Patient already on doliprane systematically for pain. No effect immediately after the vaccine. At 4.30 p.m, the patient had deterioration of his general condition. Afebrile 37. Cyanotic, gray complexion. Cool hands, no sweat, no marbling. Conscious and communicating patient. No signs of respiratory distress. Reassessed at 7 p.m. Patient always conscious. T = 37.8. Signs of shock. Pulse quick, fast, regular. Mottling+++. respiratory rate 32 without sign of distress, without indrawing. A few moans and sweats at the start of the night. Lightweight. Quiet night afterwards, patient not conscious. Death noted at 8:15 am on 05Aug2021. It is unknown if autopsy was done. No follow-up attempts are possible; no further information expected, information about lot/batch number cannot be obtained ; Reported Cause(s) of Death: Aggravation of existing disorder


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