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From the 12/24/2020 release of VAERS data (an older release, current is 6/11/2021):

This is VAERS ID 871630



Case Details

VAERS ID: 871630 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Foreign  
Vaccinated:2019-11-08
Onset:2020-04-29
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2020-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA3: INFLUENZA (SEASONAL) (CHIROMAS) / NOVARTIS VACCINES AND DIAGNOSTICS 9153B1A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-05-06
   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: Comments: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESSEQIRUS202003581

Write-up: Pneumonia from COVID-19; This is a spontaneous case, reported by pharmacist to Regulatory Authority (regulatory reference number: ES-AEMPS-630975) and initially retrieved on 21-May-2020, concerning an 89-year-old, male patient. The patient''s medical history and concomitant medications were not reported. On 08-Nov-2019, the patient was administered Chiromas (TIV) [influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; batch number: 9153B1A; dose: 0.5 ml; route of administration: intramuscular; anatomical location and expiry date: not reported] as flu vaccination. On 29-Apr-2020, five months and 21 days after vaccination, the patient developed pneumonia from COVID-19. On 06-May-2020, the patient died due to the pneumonia from COVID-19. It was unknown if the autopsy was done. The event of ''COVID-19 pneumonia'' was considered serious due to the criterion of medical significance and fatal outcome. The reporter did not provide causality assessment. This case is linked with the case 202003587 (Regulatory Authority link). Company comment: A 89-year-old, male patient experienced COVID-19 pneumonia, five months and 21 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine.; Sender''s Comments: A 89-year-old, male patient experienced COVID-19 pneumonia, five months and 21 days after administration of Chiromas (TIV) influenza vaccine. Reportedly, the patient died due to COVID-19 pneumonia. It was unknown if autopsy was performed. Considering infectious aetiology of the event and biological implausibility, the causality is assessed as not related to the suspect vaccine. ES-AEMPS-630523:; Reported Cause(s) of Death: Pneumonia from COVID-19


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