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

This is VAERS ID 873254



Case Details

VAERS ID: 873254 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Foreign  
Vaccinated:2019-11-05
Onset:2020-04-06
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2020-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS NO BATCH NUMBER / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, 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 (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-04-16
   Days after onset: 10
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: ESSEQIRUS202003802

Write-up: Pneumonia from COVID-19; Acute respiratory failure; This is a spontaneous case , reported by pharmacist (regulatory reference number: ES-AEMPS-638333) and initially retrieved on 11-Jun-2020, concerning a 86-year-old male 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; route of administration: intramuscular, dose reported as one, batch number, anatomical location and expiry date: not reported] for flu vaccination. On 06-Apr-2020, five months and one day after vaccination, the patient developed pneumonia from COVID-19 and acute respiratory failure. On 16-Apr-2020, the patient died. Cause of death were pneumonia from COVID-19 and acute respiratory failure. It was unknown if autopsy was done. The events of COVID-19 pneumonia and acute respiratory failure were considered serious due to seriousness criterion of death and medical significance. The reporter did not provide causality assessment to Chiromas (TIV). This case is linked with the case 202003587 (Regulatory Authority link). Company comment: A 86-year-old, male patient experienced COVID-19 pneumonia and acute respiratory failure, five months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia and acute respiratory failure. It was unknown if autopsy was performed. The event of acute respiratory failure was likely associated with COVID-19. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 86-year-old, male patient experienced COVID-19 pneumonia and acute respiratory failure, five months after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia and acute respiratory failure. It was unknown if autopsy was performed. The event of acute respiratory failure was likely associated with COVID-19. Considering unsuggestive chronology and biological implausibility, causality is assessed as not related to the suspect vaccine. ES-SEQIRUS-202003587:Regulatory authority link ES-AEMPS-630523:; Reported Cause(s) of Death: Pneumonia from COVID-19; Acute respiratory failure


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