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

This is VAERS ID 873194



Case Details

VAERS ID: 873194 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Foreign  
Vaccinated:2019-11-14
Onset:2020-03-30
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2020-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS 9153A1A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-04-21
   Days after onset: 22
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: ESSEQIRUS202003770

Write-up: Respiratory infection by COVID-19; Acute respiratory insufficiency; This is a spontaneous case reported by pharmacist to Regulatory Authority (reference number: ES-AEMPS-635507) and initially retrieved on 08-Jun-2020, concerning a 79-year-old, male patient. The patient''s medical history and concomitant medications were not reported. On 14-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; route of administration: intramuscular, dose reported as one, batch number, anatomical location and expiry date: not reported] for flu vaccination. On 30-Mar-2020, four months and sixteen days after vaccination, the patient developed acute respiratory insufficiency and respiratory infection by COVID-19. On 21-Apr-2020, the patient died. Cause of death was acute respiratory insufficiency and respiratory infection by COVID-19. It was unknown if autopsy was done. The events of ‘acute respiratory insufficiency'' and ‘respiratory infection by COVID-19'' were considered serious due to the criterion of death. The reporter did not provide causality assessment to Chiromas (TIV). This case is linked with the case 202003587 (Regulatory Authority link). Company comment: A 79-year-old male patient developed COVID-19 and acute respiratory failure four months and sixteen days after vaccination with the suspect product Chiromas (TIV) for flu. Chronology seems unsuggestive. On 21-Apr-2020, the patient died. Cause of death was acute respiratory insufficiency and respiratory infection by COVID-19. It was unknown if autopsy was done. The patient''s medical history and concomitant medications were not reported. With information presented, causality is assessed as unrelated to the product for both events. COVID provides more plausible aetiology.; Sender''s Comments: A 79-year-old male patient developed COVID-19 and acute respiratory failure four months and sixteen days after vaccination with the suspect product Chiromas (TIV) for flu. Chronology seems unsuggestive. On 21-Apr-2020, the patient died. Cause of death was acute respiratory insufficiency and respiratory infection by COVID-19. It was unknown if autopsy was done. The patient''s medical history and concomitant medications were not reported. With information presented, causality is assessed as unrelated to the product for both events. COVID provides more plausible aetiology. ES-SEQIRUS-202003587:Regulatory authority link; Reported Cause(s) of Death: Respiratory infection by COVID-19; Acute respiratory insufficiency


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