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

This is VAERS ID 1219334



Case Details

VAERS ID: 1219334 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-17
Onset:2021-03-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   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, amlodipine, aspirin, atorvastatin, cholecalciferol, diphenhydramine, glipizide, melatonin
Current Illness: hypertension, uncontrolled type 2 diabetes, hyperlipidemia, COPD, sleep apnea, tobacco use, alcohol abuse, cocaine abuse
Preexisting Conditions: hypertension, uncontrolled type 2 diabetes, hyperlipidemia, COPD, sleep apnea, tobacco use, alcohol abuse, cocaine abuse
Allergies: tramadol, lisinopril
Diagnostic Lab Data: no autopsy performed
CDC Split Type:

Write-up: Death on 3/22. Unknown cause. Family found him unresponsive. Did not pursue autopsy.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1219334

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