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

This is VAERS ID 1063522



Case Details

VAERS ID: 1063522 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-23
Onset:2021-02-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Chills, Death, Decreased appetite, Electrocardiogram, Fatigue, Flank pain, Gait inability, Pyrexia, Resuscitation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Xarelto 20mg 2. Digoxin 125mcg 3. Aterbastatin 10mg 4. Escitalopram 10mg 5. Lopressor 50mg 6. Spironolactone 25mg 7. Lasix 20mg 8. Gabapentin 200mg 9. Diazepam 5mg 10. Lisinopril 2.5mg 11. Tylenol 800mg 12. Breoellieta 200/25 13. Spiriva
Current Illness: No new or acute illnesses reported within the last month
Preexisting Conditions: 1. Multiple myeloma 2. Atrial Fibrillation 3. COPD ? Emphysema/Asthma 4. Congested Heart Failure 5. Macular degeneration 6. Normal Sp02 ? 90%-92%
Allergies: 1. Entresto
Diagnostic Lab Data: 1. 2/24/2021 at 18:35 ? 12-Lead EKG ? Paramedics 2. 2/24/2021 at 18:30 ? Vital Signs ? Paramedics 3. 2/24/2021 at 13:06 ? Vital Signs ? Paramedics 4. 2/24/2021 at 13:11 ? 12-Lead EKG ? Paramedics 5. 2/24/2021 at 13:06 ? Glucose Check ? Paramedics 6. 2/27/2021 at 01:32 ? Cardiac Arrest Protocol - Paramedics
CDC Split Type:

Write-up: 1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3 - Thursday 9. Ambulatory - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1063522

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