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

This is VAERS ID 955800



Case Details

VAERS ID: 955800 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2020-12-17
Onset:2020-12-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EI0553 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ; ; MONOMIL XL; ; ORAMORPH; PREDNISON;
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic lymphocytic leukaemia; IHD; Lung cancer metastatic (FROM CA LUNG); NIDDM
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021034127

Write-up: Vomiting; This is a spontaneous report from a contactable physician. This is a report received from the regulatory authority. Regulatory authority report number GB-MHRA-WEBCOVID-20201230095817, Sender''s Safety Report Unique Identifier GB-MHRA-ADR 24548721. A 89-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) (Lot/Batch number EI0553), via an unspecified route of administration on 17Dec2020 at single dose for COVID-19 immunization. Medical history included metastatic neoplasm (from CA lung), myocardial ischaemia (IHD) and type 2 diabetes mellitus (NIDDM) from unknown dates and unknown if ongoing and chronic lymphocytic leukaemia from 2019. Concomitant medication included amlodipine for IHD, atorvastatin for IHD, isosorbide mononitrate (MONOMIL XL) for IHD, omeprazole for hyperacidity, morphine sulfate pentahydrate (ORAMORPH) for palliative care, prednisone for palliative care, influenza vaccine (INFLUENZA VACCINE SEQIRUS) on 10Oct2020 for immunization, ticagrelor for IHD and steroids at 65 mg. The patient experienced vomiting on 18Dec2020, which was fatal. This man was terminally ill but commenced vomiting approximately 12 hours after vaccine administration. This vomiting continued for three days until his death. The patient died on 21Dec2020 due to vomiting. It was not reported if an autopsy was performed. Patient has not tested positive for Coronavirus disease 2019 since having the vaccine. Patient has not had symptoms associated with Coronavirus disease 2019. Patient has not been tested/or has had an inconclusive test for Coronavirus disease 2019. Patient is not enrolled in clinical trial. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Vomiting


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