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

This is VAERS ID 1348004

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Case Details

VAERS ID: 1348004 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood culture, COVID-19, Computerised tomogram, SARS-CoV-2 test positive, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 10
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: AFib; Ischaemic heart disease (Stented ischemic heart disease)
Preexisting Conditions: Medical History/Concurrent Conditions: Appendectomy; Arrhythmia (complete arrhythmia by atrial fibrillation anticoagulated and treated with amiodarone); BPH (benign prostatic hyperplasia with 2 transurethral resection of the prostate); Cataract (left); Cholecystectomy; Defibrillation; Glaucoma; Hypotension (Syncope due to severe hypotension, hospitalized in 2014 with malaise); Knee meniscectomy; Malaise (Syncope due to severe hypotension, hospitalized in 2014 with malaise); Pacemaker insertion (cardiac); Parkinson''s disease; Right inguinal hernia; Syncope (Syncope due to severe hypotension, hospitalized in 2014 with malaise); Transurethral prostatectomy
Diagnostic Lab Data: Test Name: blood culture; Test Result: Negative ; Test Name: Computerised tomography chest scan; Result Unstructured Data: Test Result:in favour; Test Date: 20210426; Test Name: COVID-19 virus test positive; Test Result: Positive
CDC Split Type: FRPFIZER INC2021572956

Write-up: Vaccination failure; covid-19/respiratory distress; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-2021053331. A 93-year-old male patient received bnt162b2 (COMIRNATY), dose 2 intramuscular on 31Mar2021 (Batch/Lot Number: ER9470) as single dose; dose 1 via an unspecified route of administration on Mar2021 (Batch/Lot number was not reported) as single dose for covid-19 immunization. Medical history included ongoing stented ischemic heart disease, ongoing atrial fibrillation, Syncope due to severe hypotension and hospitalized in 2014 with malaise, complete arrhythmia by atrial fibrillation anticoagulated and treated with amiodarone (defibrillation on 10Sep2014), pacemaker in 2015, benign prostatic hypertrophy (2 transurethral resections of the prostate), glaucoma, cataract left eye, cholecystectomy, appendicectomy, Right inguinal hernia cure, Meniscectomy right knee and Parkinson''s (as reported). The patient had no allergy. The patient''s concomitant medications were not reported. Patient who completed his complete vaccination schedule with Comirnaty with administration of the 2nd dose on 31Mar2021. The patient had COVID on 26Apr2021 (26 days after the 2nd dose). Computerized tomography chest scan in favour. Negative blood culture. The patient was however placed on antibiotics. Death of the patient from respiratory distress on 06May2021. Overall, vaccine failure with COVID-19 infection 26 days after the 2nd dose of Comirnaty. The patient was hospitalized due to the event. The patient underwent lab tests and procedures which included COVID-19 virus test positive on 26Apr2021. The patient died on 06May2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. Information on batch/lot number already obtained.; Reported Cause(s) of Death: COVID-19; Distress respiratory/COVID-19

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