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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1027619



Case Details

VAERS ID: 1027619 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-10
Onset:2021-02-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Pain in extremity, Peripheral swelling, Resuscitation, Unresponsive to stimuli
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no acute
Preexisting Conditions: Anemia, unspecified Congenital malformation syndromes predominantly associated with short stature Constipation, unspecified Dysphagia, unspecified Gastro-esophageal reflux disease without esophagitis Illness, unspecified Intermittent explosive disorder Moderate intellectual disabilities Neuromuscular dysfunction of bladder, unspecified Other iron deficiency anemias Other specified eating disorder Pica of infancy and childhood Thrombocytopenia,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen leg/pain- taken to urgent care- became unresponsive - CPR initiated- expired


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