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From the 10/8/2021 release of VAERS data:

This is VAERS ID 955792



Case Details

VAERS ID: 955792 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2020-12-22
Onset:2020-12-01
Submitted: 0000-00-00
Entered: 2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Angioedema, Blood culture, Coma scale abnormal, Depressed level of consciousness, Dyspnoea, Hypotension, Hypothermia, Malaise, Multiple organ dysfunction syndrome, Oxygen saturation decreased, Pruritus, Rash, Rash maculo-papular, Skin exfoliation, Stevens-Johnson syndrome, Swelling face, Toxic epidermal necrolysis
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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 (narrow), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-29
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Eczema; Fruit allergy
Allergies:
Diagnostic Lab Data: Test Name: Blood culture; Test Result: Negative
CDC Split Type: GBPFIZER INC2021028075

Write-up: Angioedema; Depressed level of consciousness; Toxic epidermal necrolysis; Oxygen saturation decreased; Hypotension; Skin exfoliation; Coma scale abnormal; Rash maculo-papular; Hypothermia; Pruritus; Rash; Swelling face; shortness of breath; felt a bit unwell; Possible anaphylaxis; Multi-organ failure; Steven Johnson syndrome; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB GB-MHRA-ADR 24566668. An 86-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via unknown route on 22Dec2020 at single dose for covid-19 vaccination. Medical history included food allergy: pineapple from an unknown date and unknown if ongoing, and eczema. The patient''s concomitant medications were not reported. The patient experienced swelling face on 25Dec2020, angioedema, depressed level of consciousness, rash maculo-papular, hypotension, hypothermia, pruritus, oxygen saturation decreased, rash, skin exfoliation, coma scale abnormal, toxic epidermal necrolysis on 28Dec2020. All these events were reported as serous per death and hospitalization. Outcome was reported as fatal. The patient also experienced Multi-organ failure, possible anaphylaxis, Steven Johnson syndrome on an unspecified date in Dec2020, felt a bit unwell on 25Dec2020, shortness of breath on 27Dec2020. Seriousness for these events was not provided. Outcome of these events was not provided. The patient died on 29Dec2020. An autopsy was not performed. Medical cause of death was reported as toxic epidermal necrolysis and multi-organ failure. Event details: Family noted on Christmas day he had dinner with them all and noticed his face was swollen and he felt a bit unwell. Possible anaphylaxis, Steven Johnson syndrome as a result of covid-19 vaccination. Patient presented 5 days post COVID-19 vaccine with shortness of breath. On Examination: peeling skin and widespread macula-papular rash and brown scaling over scalp, angiodema, itchy, reduced conciousness, desaturating, hypothermia and hypotensive. Multi-organ failure. Administered hydrocortisone IV (intravenous) and 2 x 0.5mL of adrenaline + fluids - some improvement in GCS (Glasgow coma scale) but not fully rousable onward - decision was made to place on ICP (integrated care pathway). Blood cultures negative. No follow-up attempts are possible, information on batch numbers cannot be obtained.; Reported Cause(s) of Death: multi-organ failure; Toxic epidermal necrolysis


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