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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1339152

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Case Details

VAERS ID: 1339152 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Chills, Clostridium test, Drug ineffective, SARS-CoV-2 test, Urosepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anal fistula; Appendectomy; Atherosclerosis generalised; Diabetes mellitus; Hypertension; Hyperuricaemia; Obesity; Pneumonia; Polyarthritis; Renal insufficiency; Spondylosis; Vertebrobasilar insufficiency
Diagnostic Lab Data: Test Name: Clostridium test positive; Test Result: Positive ; Test Date: 20210319; Test Name: COVID-19 antigen test negative; Test Result: Negative ; Test Date: 20210320; Test Name: COVID-19 PCR test positive; Test Result: Positive
CDC Split Type: HUPFIZER INC2021559798

Write-up: COVID-19 infection; drug ineffective/COVID-19; Acute renal insufficiency; Urosepsis; chills without fever; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB HU-OGYI-288921. A 77-year-old male patient received the first dose of BNT162B2 (COMIRNATY, concentrate for dispersion for injection tozinameran (COVID-19 mRNA Vaccine embedded in lipid nanoparticles), lot number: ET1831, expiry date: unknown: BioNTech Manufacturing Pfizer) intramuscularly on 05Mar2021 at 0.3 ml single dose for COVID-19 immunization. Medical history included appendectomy, anal fistula, diabetes mellitus, hypertension, hyperuricemia, obesity, pneumonia, polyarthritis, renal insufficiency, spondylosis, vertebrobasilar insufficiency and generalized atherosclerosis. Concomitant drugs were hydrochloride/vildagliptin (EUCREAS), famotidine (APO-FAMOTIDIN), acetylsalicylic acid (ASA PROTECT PHARMAVIT), bisoprolol fumarate (BISOBLOCK), amlodipine besilate, indapamide/ perindopril arginine (COVERCARD PLUS), allopurinol (MILURIT), tiotropium bromide (SPIRIVA) and amlodipine besilate/atorvastatin calcium/ perindopril arginine (VALONGIX). On 19Mar2021 the patient was admitted in the hospital because of urosepsis, acute renal insufficiency and needed mechanical ventilation. Before hospitalization, the patient was experiencing chills for 2 days without fever. A covid antigen test was done in the ambulance which came back negative on 19Mar2021, but on 20Mar2021 a PCR test confirmed the Covid-19 infection. On 03Apr2021 the patient passed away. It was unknown if autopsy was done. The direct cause of death was COVID-19. The outcome of events urosepsis, acute renal insufficiency, COVID-19 was reported as fatal ( urosepsis, acute renal insufficiency were not reported as cause of death), outcome of chills was unknown. Sender Comment: The causal relationship is unlikely between the suspected drug and the adverse events as the cause of death was determined to be Covid-19. The case is considered serious because the outcome was fatal. Further information is not expected. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: COVID-19

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