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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1454552

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Case Details

VAERS ID: 1454552 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-06-28
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-07-07
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: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, Erythema, General physical health deterioration, SARS-CoV-2 test positive, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel Atorvastatin Lisinopril Nebivolol Aspirin Ferric Citrate Docusate Sodium Lactobacillus Acidophilus Insulin Glargine Insulin Lispro Levothyroxine
Current Illness: Diabetes End Stage renal disease on dialysis peripheral vascular disease Coronary artery disease status post stent placement Non-healing lesion of right heel
Preexisting Conditions: Diabetes End Stage renal disease on dialysis peripheral vascular disease Coronary artery disease status post stent placement Non-healing lesion of right heel
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21


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