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

This is VAERS ID 1178158



Case Details

VAERS ID: 1178158 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aggression, Blood gases, Coagulation test, Confusional state, Death, Dyspnoea, Endocrine test, Endotracheal intubation, Full blood count, Laboratory test, Myocardial necrosis marker, Rash, SARS-CoV-2 test negative, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unkown
Preexisting Conditions: Chronic Kidney Disease, chronic steroid use, pneumonia, SOB, Sepsis, psoriatic arthritis, Psoriasis, Type 2 Diabetes, Hyperkalemia, COPD, Status Epilect
Allergies: Calcipotriene, Ceftiaxone, neomycin, polymyxin antibiotics,
Diagnostic Lab Data: COVID test PCR negative, blood gases, CBC with diff, routine chemistry, Coagulation Studies, Cardiac Markers, Infectious Disease, Endocrinology, UA
CDC Split Type:

Write-up: Pt came to the ER via ambulance with SOB, difficulty breathing, confusion and combativeness which had gotten worse over the day 4/3/21. He had a rash all over his body.. After the respiratory treatments failed, pt was intubated and transferred to a higher level of care and expired on 4/4/21


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1178158

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