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

This is VAERS ID 1433513



Case Details

VAERS ID: 1433513 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-04-27
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: REFUSED BY PATIENT
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DOD 4/27/21 AT HOSPICE. SPOKE WITH PATIENT 4/13 AND REPORTS HOSPITALIZATION NOT DUE TO COVID


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433513

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