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

This is VAERS ID 1034055



Case Details

VAERS ID: 1034055 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-02-11
Onset:2021-02-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Kidney Failure- on dialysis
Preexisting Conditions: Kidney Failure- on dialysis
Allergies: UNKNOWN- none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Associate developed SOB on 2/12/21. Taken to Hospital on 2/13/21. Reported deceased 2/14/21.


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