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

This is VAERS ID 1046265



Case Details

VAERS ID: 1046265 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-19
Onset:2021-02-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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:
Current Illness:
Preexisting Conditions: A-fib, dementia, BPH, HTN, CEREBROVASCULAR DISEASE and anemia.
Allergies: No known allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received 2nd dose of COVID19 Pfizer vaccine at 1103 am on 2/19/21, was last seen at 1159, found around 1615 by kitchen staff who were serving dinner.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1046265

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