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

This is VAERS ID 1105193



Case Details

VAERS ID: 1105193 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Pulmonary fibrosis
SMQs:, Interstitial lung disease (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   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: acetaminophen, benzonatate, clopidogrel, cyclobenzaprine, docusate-senna prn, doxylamine, escitalopram, fluticasone topical, furosemide, hydrocortisone topical, latanoprost ophthalmic, levothyroxine, metformin, midodrine, nitroglycerin prn,
Current Illness: Patient was hospitalized from 1/31- 2/4 with SARS- COVID-19 pneumonia.
Preexisting Conditions: chronic hypoxemic respiratory failure, pulmonary fibrosis, coronary artery disease, diastolic heart failure, ALS, type 2 diabetes, obesity, hypothyroidism, BPH, anemia, degenerative lumbar disc disease, diverticulosis, gout, hyperlipidemia, ocular hypertension, orthostatic hypotension, sleep apnea
Allergies: celebrex, penicillin, sulfa drugs, tramadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death due to pulmonary fibrosis


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