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

This is VAERS ID 1361447



Case Details

VAERS ID: 1361447 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-02
Onset:2021-04-15
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Cough, Death, Lung opacity, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), 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), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: CT Scan with ground glass appearance.
CDC Split Type:

Write-up: Patient developed cough about one month after the second dose of his vaccine. He does not have history of underlying lung disease. His CT scan showed diffuse ground glass appearance. Developed progressive and rapid respiratory failure. He was admitted to hospital on 5/13 and expired 5/30.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1361447

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