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

This is VAERS ID 871632



Case Details

VAERS ID: 871632 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Foreign  
Vaccinated:2019-12-04
Onset:2020-03-26
   Days after vaccination:113
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: 2020-03-30
   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: ESSEQIRUS202003585

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by a pharmacist to regulatory authority (regulatory reference number: ES-AEMPS-630996) and initially retrieved on 21-May-2020, concerning an 84-year-old, female patient. The patient''s medical history and concomitant medications were not provided. On 04-Dec-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 expiry date: not reported] for flu vaccination. On 26-Mar-2020, 3 months 22 days after vaccination, the patient developed pneumonia from COVID-19. On 30-Mar-2020, the patient died and pneumonia from COVID-19 was reported as cause of death. It was unknown if autopsy was performed. The event of ‘COVID-19 pneumonia'' was considered serious due to criteria of death and medical significance. The reporter did not provide a causality assessment to Chiromas (TIV). This case is linked to case 202003587 (Regulatory Authority link). Company comment: A 84-year-old, female patient experienced COVID-19 pneumonia, 3 months 22 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to pneumonia from COVID-19. It was unknown if 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 84-year-old, female patient experienced COVID-19 pneumonia, 3 months 22 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to pneumonia from COVID-19. It was unknown if 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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