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

This is VAERS ID 1230371



Case Details

VAERS ID: 1230371 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-10
Onset:2021-04-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death, Presyncope
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   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: ? Buproprion-XL 300 mg extended release tablet daily ? Folic acid 1 mg tablet daily ? Docusate 100mg twice daily ? Gabapentin 300mg twice daily ? Hydrocodone-APAP 10-325 mg 1 tablet every 6 hours as needed. ? Hydromorphone 8 mg table by mo
Current Illness:
Preexisting Conditions: ? Hypertension ? Hemoglobin s/beta thalassemia ? Dysthymic disorder ? Sickle cell pain crisis Low Testosterone
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 4/13 after presenting to local hospital with near syncope and AKI. Records from local hospital are unavailable, unclear regarding cause of death and circumstances thereforth.


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