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

This is VAERS ID 1338072

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Case Details

VAERS ID: 1338072 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Cough, Musculoskeletal pain, Pneumonia, Pyrexia, SARS-CoV-2 test, SARS-CoV-2 test positive, Sneezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 12
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: Celiac disease; Chronic kidney disease; Dyslipidaemia; Gastrooesophageal reflux; Hypertension arterial; Hypoacusis; Ischaemic heart disease; Obesity (BMI 33); Sleep apnea
Diagnostic Lab Data: Test Date: 20210503; Test Name: body temperature; Result Unstructured Data: Test Result:38.5 Centigrade; Test Date: 20210503; Test Name: body temperature; Result Unstructured Data: Test Result:38.7 Centigrade; Test Date: 20210506; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: ESPFIZER INC2021559947

Write-up: bilateral pneumonia; covid-positive pcr; 38,5�C, 38,7�C; Shivering; Cough; Sneezing; Arthromyalgia; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB ES-AEMPS-863640. A 83-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 30Apr2021 (Lot Number: EY3014) as SINGLE DOSE for covid-19 immunisation. Medical history included hypertension arterial, sleep apnea, obesity, chronic kidney disease, celiac disease, hypoacusis, gastrooesophageal reflux, ischaemic heart disease, dyslipidaemia. The patient''s concomitant medications were not reported. The patient experienced cough (death, hospitalization, medically significant) on 30Apr2021, sneezing (death, hospitalization, medically significant) on 30Apr2021, arthromyalgia (death, hospitalization, medically significant) on 30Apr2021, shivering (death, hospitalization, medically significant) on 01May2021, 38,5�c, 38,7�c (death, hospitalization, medically significant) on 03May2021, bilateral pneumonia (death, hospitalization, medically significant) on 06May2021, covid-positive pcr (death, hospitalization, medically significant) on 06May2021. The patient died on 12May2021. It was not reported if an autopsy was performed. Treatment included solumoderin + nolotil 575mg + paracetamol 1000mg + pectoxlisine + oxygen + dexamethasone + ethylprednisolone + ceftriaxone + hbpm. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: bilateral pneumonia; covid-positive pcr; Shivering; Cough; Sneezing; Arthromyalgia; 38,5�C, 38,7�C

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