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

This is VAERS ID 1172708



Case Details

VAERS ID: 1172708 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-30
Onset:2021-04-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiomegaly, Death, Hypertension, Pain in extremity
SMQs:, Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   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: Family was not certain. Believe medications for high blood pressure, blood clots, tylenol, and maybe some other meds. He also drank 1 pint of gin each day and smoked medical marijuana
Current Illness: Walking Pneumonia (family wasn''t sure)
Preexisting Conditions: Fatty liver from alcohol Blood clots in legs High blood pressure Enlarged heart (report from coroner)
Allergies: none
Diagnostic Lab Data: Coroner reported that patient was hypertensive and had a very enlarged heart
CDC Split Type:

Write-up: No acute symptoms after vaccine except a mildly sore arm. Patient died 4 days later


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