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

This is VAERS ID 1033444



Case Details

VAERS ID: 1033444 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-16
Onset:2021-01-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / UN

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Condition aggravated
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: congestive heart disease medications
Current Illness: Addison''s disease, abdominal hernia
Preexisting Conditions: Congestive heart disease Addison''s disease
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: symptoms of ongoing congestive heart disease just progressed


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1033444


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