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

This is VAERS ID 890335



Case Details

VAERS ID: 890335 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Foreign  
Vaccinated:2019-11-04
Onset:2020-07-01
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2020-10-16
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: 2020-07-03
   Days after onset: 2
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: ESSEQIRUS202005215

Write-up: Pneumonia from COVID-19; This spontaneous case was retrieved on 15-Oct-2020 from regulatory reference number: ES-AEMPS-679931), reported by a pharmacist and concerned a 92-year-old, male patient. The patient''s medical history and concomitant medications were not reported. On 04-Nov-2019, the patient was vaccinated with Chiromas (TIV) (influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, MF59; dose reported as single dose, route of administration: intramuscular and anatomical location: not reported) as flu vaccination. The batch number reported was 9153B1A. On 01-Jul-2020, seven months and 27 days after receiving Chiromas (TIV), the patient developed pneumonia from COVID-19. On 03-Jul-2020, the patient died due to pneumonia from COVID-19. It was unknown if the autopsy was done. The reporter did not provide causality assessment. The event of ''COVID-19 pneumonia'' was considered serious due to the criterion of medical significance and fatal outcome by a Physician within Seqirus'' Pharmacovigilance and Risk Management Department. Company comment: The 92-year-old patient was administered suspect product, Chiromas (TIV). Reportedly, approximately eight months after vaccination, the patient developed COVID-19 pneumonia. Chronology is unsuggestive. It was reported that the patient died due to COVID-19 pneumonia. It was not reported whether autopsy was performed. The patient''s medical history and concomitant medications were not reported. Considering biological and chronological implausibility, causal role of the suspect vaccine is assessed as not related.; Sender''s Comments: The 92-year-old patient was administered suspect product, Chiromas (TIV). Reportedly, approximately eight months after vaccination, the patient developed COVID-19 pneumonia. Chronology is unsuggestive. It was reported that the patient died due to COVID-19 pneumonia. It was not reported whether autopsy was performed. The patient''s medical history and concomitant medications were not reported. Considering biological and chronological implausibility, causal role of the suspect vaccine is assessed as not related. ES-AEMPS-630523:; Reported Cause(s) of Death: Pneumonia from COVID-19


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