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

This is VAERS ID 1371438



Case Details

VAERS ID: 1371438 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-16
Onset:2021-06-01
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Client tested positive for COVID-19 on 5/18/21 client died of COVID pneumonia on 6/1/21
CDC Split Type:

Write-up: Clinet was vaccinated on 2/16/21 and on 3/9/21


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371438

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