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

This is VAERS ID 978336



Case Details

VAERS ID: 978336 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Foreign  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, Drug ineffective, Multiple organ dysfunction syndrome, Pulmonary sepsis
SMQs:, Lack of efficacy/effect (narrow), 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-06
   Days after onset: 7
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021060589

Write-up: COVID-19 pneumonia; COVID-19 pneumonia; Pneumogenic sepsis; Consecutive multiple organ failure; This is a spontaneous report from a non-contactable physician downloaded from the Medicines Agency (MA) Regulatory Authority-WEB DE-PEI-PEI2021000830. A 74-year-old male patient received first dose of BNT162B2 (COMIRNATY; lot number and expiry date were not reported), via an unspecified route of administration on 30Dec2020 at a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On 30Dec2020, the same day after vaccination, the patient developed COVID-19 pneumonia, pulmonary sepsis also reported as pneumogenic sepsis, and consecutive multiorgan failure. The patient died on 06Jan2021. An autopsy was performed that revealed COVID-19 pneumonia. Information on the batch number has been requested.; Reported Cause(s) of Death: COVID-19 pneumonia; Pneumogenic sepsis; multiple organ failure; Autopsy-determined Cause(s) of Death: COVID-19 pneumonia


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