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From the 4/30/2021 release of VAERS data:

This is VAERS ID 871631



Case Details

VAERS ID: 871631 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Foreign  
Vaccinated:2019-11-04
Onset:2020-03-20
   Days after vaccination:137
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: 2020-03-24
   Days after onset: 4
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: ESSEQIRUS202003582

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by a pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630989) and initially retrieved on 21-May-2020, concerning a 73-year-old, male patient. The patient''s relevant medical history and concomitant medications were not reported. On 04-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59; dose: 0.5 ml, route of administration: intramuscular, batch number: 9153B1A, anatomical location and expiration date: not reported] for flu vaccination. On 20-Mar-2020, the patient developed pneumonia due to coronavirus infection COVID-19. On 24-Mar-2020, the patient died due to COVID-19 pneumonia. It was unknown whether autopsy was performed. The event of COVID-19 pneumonia was considered as serious due to seriousness criteria of death and medical significance (per company). The reporter did not provide causality assessment to Chiromas (TIV). This case is linked to case 202003587 as regulatory authority link. Company comment: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 73-year-old, male patient experienced COVID-19 pneumonia, 4 months 16 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown whether an autopsy was performed. 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: Pneumonia from COVID-19


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