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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1328783

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Case Details

VAERS ID: 1328783 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Asthma, Body temperature, Dyspnoea, Oxygen saturation, Oxygen saturation decreased, Pneumonia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Test Date: 20210508; Test Name: Body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: Before vaccination; Test Date: 20210508; Test Name: SpO2; Test Result: 94 %; Comments: 16:30 room air; Test Date: 20210508; Test Name: SpO2; Result Unstructured Data: Test Result:89- 91 %; Comments: After IV drip decreasing tendency; Test Date: 20210508; Test Name: SpO2; Result Unstructured Data: Test Result:89-92 %; Comments: on admission room air Oxygen 3L/min; Test Date: 20210509; Test Name: SpO2; Result Unstructured Data: Test Result:89-90 %; Comments: 03:30 Oxygen 5L/min; Test Date: 20210509; Test Name: SpO2; Result Unstructured Data: Test Result:89 - 94 %; Comments: 06:52 Oxygen 5L/min; Test Date: 20210509; Test Name: SpO2; Result Unstructured Data: Test Result:88-89 %; Comments: 09:50 Oxygen 10L/min; Test Date: 20210509; Test Name: SpO2; Test Result: 89 %; Comments: 11:20
CDC Split Type: JPPFIZER INC2021549715

Write-up: Acute pneumonia; bronchial asthma; breathing difficulty/inspiratory dyspnoea; wheezing; SpO2 Oxygen saturation 89- 91, SpO2 Oxygen saturation 88-89; This is a spontaneous report from a contactable physician received from a regulatory authority. Regulatory authority report number is v21106433. A 81-years-old male ( also reported as 81-year and 10-month-old) patient received the first dose bnt162b2 (COMIRNATY), via an unspecified route of administration on 08May2021 13:30 (also reported as ''from 13:30 to 14:30 (the day of vaccination),'' at the age of 81 years old (Batch/Lot Number: EW4811; Expiration Date: 31Jul2021) 0.3 ml, single for covid-19 immunization. The patient medical history was not reported. Body temperature before vaccination was 36.3 degrees Centigrade. The patient was receiving blood-thinner medicine and medicines for blood pressure. No information on family history was provided. On 08May2021 16:30, The patient experienced acute pneumonia (death, hospitalization) on 08May2021 16:30 , bronchial asthma (death, hospitalization), breathing difficulty/inspiratory, wheezing and spo2 oxygen saturation 89- 91, spo2 oxygen saturation 88-89. The adverse event involved emergency room visit and hospitalization. The patient was hospitalized from 08May2021 to 09May2021. The patient underwent lab tests and procedures which included body temperature: 36.3 centigrade on 08May2021 Before vaccination , oxygen saturation: 94 % on 08May2021 16:30 room air , oxygen saturation: 89- 91 % on 08May2021 After IV drip decreasing tendency , oxygen saturation: 89-92 % on 08May2021 on admission room air Oxygen 3L/min , oxygen saturation: 89-90 % on 09May2021 03:30 Oxygen 5L/min , oxygen saturation: 89 - 94 % on 09May2021 06:52 Oxygen 5L/min , oxygen saturation: 88-89 % on 09May2021 09:50 Oxygen 10L/min , oxygen saturation: 89 % on 09May2021 11:20. Treatment was given for the events. The clinical outcome of the events pneumonia and bronchial asthma was fatal while the remaining events was unknown. The patient died on 09May2021. It was not reported if an autopsy was performed. The course of the event was as follows: On 08May2021 from around 16:30, the symptoms (such as breathing difficulty, wheezing, and inspiratory dyspnoea) started to appear. SpO2 (oxygen saturation percutaneous) was 94% (room air). On 08May2021 at 19:49, the patient visited the emergency department of the reporter''s hospital as an outpatient where IV drip (SOLDEM 1 200 mL, 1 bottle and SOLU-CORTEF 250 mg, 1 bottle), and inhalation (inhalator, VENETLIN 0.3 mL and normal saline solution 2.0 mL) were administered. After IV drip was completed, SpO2 of 89% - 91% (decreasing tendency) and worsening of wheezing were noted. As the possibility of adverse reactions was suspected, the patient was hospitalized for the purpose of observation of his progress (at 22:00 on 08May2021). At the time of admission (from 22:00), oxygen administration (3L/min, SpO2 of 89% - 92%, room air) was started. Wheezing on exertion was worsened. On 09May2021 at 03:30, oxygen flow rate was changed to 5L/min (SpO2 of 89% - 90%) because of worsening of wheezing and decreased SpO2. On 09May2021 at 06:52, oxygen flow rate was set at 5L/min (SpO2 of 89% - 94%). On 09May2021 at 08:31, DECADRON injection, 3.3 mg, 1 ampule was intravenously administered. On 09May2021 at 09:50, as SpO2 was decreased, oxygen flow rate was changed to 10L/min (SpO2 of 88% - 89%), PCR test was performed (the result was negative), consciousness disturbed (JCS [coma scale]-2) was noted. On 09May2021 at 11:00, indwelling bladder catheter was inserted. On 09May2021 at 11:20, TAZOPIPE for combination injection, 4.5 mg was administered (2 kits in total) (SpO2 89%). On 09May2021 at 14:40, disimpaction was performed (glycerin enema 50%, 60 mL). On 09May2021 at 14:50, furosemide injection 20 mg, 1 ampule was administered. On 09May2021 at 16:00, his breathing was stopped (JCS-300), cardiac massage was started. Adrenaline injection 0.1% syringe was administered. Prevaccination Screening Questionnaire for COVID-19 vaccine as follow: Have you read the Instructions for the COVID-19 vaccine and do you understand the effects and adverse side effects?:Yes Are you currently suffering from any kind of illness and receiving treatment or medication? ?:Yes Name of disease:(Blank), Nature of treatment: blood-thinning medicine and medicine for blood pressure Has a doctor who is treating you for the disease told you that you can have the vaccine today?:No Have you had a fever or gotten sick in the last month?:No Are there any parts of your body that are not feeling well today?:No Have you ever had a convulsion (seizure)?:No Have you ever experienced severe allergic symptoms (such as anaphylaxis) from medications or foods?:No Have you had any vaccines within the last two weeks?:No In light of the results of the questions above and examination, today''s vaccine is :possible ''(by doctor) The reporting physician classified the event as serious (death and hospitalization). There was no other possible cause of the event such as any other diseases.; Reported Cause(s) of Death: acute pneumonia; bronchial asthma

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