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

This is VAERS ID 1591265



Case Details

VAERS ID: 1591265 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-30
Onset:2021-08-01
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   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: Lomotil, Norco, Flexeril, Flonase, Calquence, Glucophage, Venclexta, Zovirax, Baraclude, Compazine, Prozac, Privigen
Current Illness:
Preexisting Conditions:
Allergies: Allopruinol, Oxycodone, Diagnostic xray material, Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/01/2021.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1591265

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