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

This is VAERS ID 1689377



Case Details

VAERS ID: 1689377 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-04
Onset:2021-08-11
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6023 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 16
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:
CDC Split Type:

Write-up: Case fully vaccinated with Pfizer. Last dose on 3/4/21. Tested positive for COVID on 8/11/2021. Admitted to Community Hospital East on 8/16/2021. Expired on 8/27/2021 while still hospitalized.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1689377

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