First of all, thank you for setting this whole template up, it's been really helpful as an initial proof of concept with fastify + drizzle + zod.
After running it, the only issue I've found was that the DB user doesn't initially have permission to access the database, so you just need to connect to the database and create & grant user privileges. After that everything works as expected.
I would suggest an initialisation script, something along these lines, to automate that part and the template would be good to go. I'm open to raising a PR with these changes if you'd like, but wanted to double check with you first.