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

This is VAERS ID 891171



Case Details

VAERS ID: 891171 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Foreign  
Vaccinated:2019-11-28
Onset:2020-03-20
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2020-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-04-16
   Days after onset: 27
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: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESSEQIRUS202005214

Write-up: COVID-19; This spontaneous case was retrieved on 15-Oct-2020 from Regulatory Authority (reference number: ES-AEMPS-679917), reported by pharmacist to and concerned a 75-year-old, female patient. The patient''s medical history and concomitant medications were not reported. On 28-Nov-2019, the patient was vaccinated with CHIROMAS (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; route of administration: intramuscular, dose reported as one, anatomical location: not reported] for flu vaccination. The batch number was not reported. On 20-Mar-2020, three months and 21 days after vaccination, the patient developed COVID-19. On 16-Apr-2020, the patient died. Cause of death was COVID-19. It was unknown if autopsy was done. The reporter did not provide causality assessment to CHIROMAS (TIV). The event of ''COVID-19'' was considered serious due to the criterion of medical significance and fatal outcome by a Physician within and Risk Management Department. Company comment: A 75-year-old, female patient was administered the suspect product, CHIROMAS (TIV). The patient developed COVID-19 infection, three months and 21 days after vaccination. Reportedly, the patient died due to COVID-19 infection. It was not reported whether autopsy was performed. The patient''s medical history and concomitant medications were not reported. Considering biological implausibility, causal role of the suspect vaccine is assessed as not related. Sender''s Comments: A 75-year-old, female patient was administered the suspect product, CHIROMAS (TIV). The patient developed COVID-19 infection, three months and 21 days after vaccination. Reportedly, the patient died due to COVID-19 infection. It was not reported whether autopsy was performed. The patient''s medical history and concomitant medications were not reported. Considering biological implausibility, causal role of the suspect vaccine is assessed as not related. ES-AEMPS-630523: Reported Cause(s) of Death: COVID-19


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