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From the 5/7/2021 release of VAERS data:

This is VAERS ID 871629



Case Details

VAERS ID: 871629 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Foreign  
Vaccinated:2019-11-05
Onset:2020-03-25
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2020-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS 9153B1A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-03-25
   Days after onset: 0
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: Comments: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESSEQIRUS202003583

Write-up: Suspected COVID-19; This is a spontaneous case reported by pharmacist to Regulatory authority (reference number: ES-AEMPS-630974) and initially retrieved on 21-May-2020, concerning a 76-year-old, female patient. The patient''s medical history and concomitant medications were not reported. On 05-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; batch number: 9153B1A; dose: 0.5 ml; route of administration: intramuscular; anatomical location and expiry date: not reported] as flu vaccination. On 25-Mar-2020, four months and twenty days after vaccination the patient developed suspected COVID-19 and died. Cause of death was reported as suspected COVID-19. It was unknown if autopsy was done. The event of ''suspected COVID-19'' was considered serious due to the criterion of fatal outcome. The reporter did not provide causality assessment to Chiromas (TIV). The case is linked to 202003587 (regulatory authority link). Company comment: A 76-year-old, female patient experienced suspected COVID-19 pneumonia, four months and twenty days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to suspected COVID-19 pneumonia. It was unknown if autopsy was performed. The patient''s medical history and concomitant medications were not reported. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 76-year-old, female patient experienced suspected COVID-19 pneumonia, four months and twenty days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to suspected COVID-19 pneumonia. It was unknown if autopsy was performed. The patient''s medical history and concomitant medications were not reported. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine. ES-AEMPS-630523: ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Suspected COVID-19


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