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

This is VAERS ID 1100951



Case Details

VAERS ID: 1100951 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-02-23
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test negative, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   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: Tylenol 325mg 2 tabs q4hrs prn; diltiazem 180mg 1 QD; glimepiride 1mg 1 BID; Humalog 3 units before meals subq; Lantus 36 units QAM; lisinopril 40mg 1 QD; metformin 1000mg 1 BID; pravastatin 40mg 1 QD; Januvia 50mg 1 QD.
Current Illness: Unknown; COVID test was negative upon death.
Preexisting Conditions: Multiple co-morbidities, including persistent atrial fibrillation, chronic diastolic heart failure, hypertension with chronic kidney disease, Type 2 diabetes, hyperlipidemia, and history of a CVA in March 2020 and a subdural hematoma from a fall (for which he was admitted from 3/17-18/20)
Allergies: NKA
Diagnostic Lab Data: COVID -19 Test was negative upon death. Other tests pending.
CDC Split Type:

Write-up: Patient was found unresponsive by family members in the early morning on 2/23/2021. Patient passed away.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1100951

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