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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1038561



Case Details

VAERS ID: 1038561 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Death, Pain, Respiratory tract congestion, Secretion discharge
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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: Trazodone
Current Illness: AAA, GERD,HTN, CAD, CA, arthritis
Preexisting Conditions: AAA, GERD, HTN, CAD, CA, arthritis
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: (02/15/2021): vaccine (02/16/2021) : severe body aches and weakness, increased congestion and mucous production. (02/16-17/2021) : death possibly during the night


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1038561

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