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

This is VAERS ID 1172981

Case Details

VAERS ID: 1172981 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Rhode Island  
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac tamponade, Death, Dyspnoea, Pericardial effusion
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, atorvastatin, glimepiride, januvia, lisinopril,loratidine, metformin, nifedipine, oxycodone-acetaminophen, senna plus, tamsulosin, tramadol & trazodone
Current Illness: metastatic adenocarcinoma of lung
Preexisting Conditions: Diabetes Type 2, COPD, hypertension, hyperlipidemia
Allergies: metformin (intolerance, diarrhea)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt developed dyspnea and decompensated due to underlying metastatic adenocarcinoma of lung and large pericardial effusion which caused cardiac tamponade ultimately causing him to succumb.

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