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

This is VAERS ID 1484524



Case Details

VAERS ID: 1484524 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-09
Onset:2021-06-30
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Potassium Chloride
Current Illness: acute kidney failure, acute respiratory failure, anemia, blepharitis, acidosis, encephalopathy, hyperkalemia, sepsis, and a previous COVID-19 diagnosis
Preexisting Conditions: developmentally delayed, seizures
Allergies: unknown
Diagnostic Lab Data: a second COVID swab was done post-mortem, those results are pending
CDC Split Type:

Write-up: death 18 days after vaccine


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484524

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