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From the 4/1/2021 release of VAERS data:

This is VAERS ID 1066093

Case Details

VAERS ID: 1066093 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2020-12-30
Onset:2021-02-02
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / UN

Administered by: Other       Purchased by: ?
Symptoms: Death, Lethargy, SARS-CoV-2 test negative
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Suboxone, aspirin, finasteride, Guaiefenesin, imodium, lisinopril, metoprolol, pantoprazole, Prostat sugar free liquid protein (pollen extracts), solifenacin, tamsulosin, Humulin
Current Illness: Hypertension, diabetes mellitus, hyperlipidemia, chronic systolic heart failure, paroxysmal atrial fibrillation, low back pain with intermittent radiculopathic symptoms, history of ruptured gastrointestinal ulcer in 2018 with resultant internal bleeding and cerebrovascular disease with right-sided neurologic deficit, neurogenic bladder with indwelling catheter, Covid-19 positive (7/2020) with subsequent negative tests 12/2020, 01/2021, and 2/2021
Preexisting Conditions: same as other illnesses
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: No known side effects; however, on 1/20 the decedent suffered lethargy. On 2/12/2021, the decedent had a possible seizure and was transported to emergency department where shortly after arrival, he was pronounced dead.


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