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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1176806



Case Details

VAERS ID: 1176806 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-19
Onset:2021-03-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP 6955 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Death, Dyspnoea, Logorrhoea, Mouth breathing, Protrusion tongue, Tongue discolouration
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dyskinesia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: tamsulosin, aflibercept DO, ranibizumab OS
Current Illness: CAD, BPH, AMD
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: OBJECTIVE: Patient found deceased on March 26, 2021, less than one week post vaccination with Pfizer-BioNTech COVID19 vaccine dose #1. Found by daughter who is also RN and caregiver. Patient found with black tongue protruding slightly from open mouth. Three days post vaccine date and for three days patient found mouth-breathing heavily. When patient?s attention was called to his breathing he immediately resumed normal breathing. Also three days post vaccine date and for three days patient had loosened waist belt and offered complaint of feeling full. Also, Patient was more talkative during the week following vaccination. SUBJECTIVE: Perhaps related to anxiety. OBJECTIVE: Patient had eaten only one avocado per day for his remaining two days of life. Patient had history of stoicism and was known to downplay or deny deviations in physical well-being.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1176806

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