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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1697379

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Case Details

VAERS ID: 1697379 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adenocarcinoma, Asthenia, Brain neoplasm, Brain operation, Death, Dehydration, Gait inability, Haemoglobin decreased, Intracranial mass, Laboratory test, Lymphoma, Neck mass, Neoplasm, Ocular neoplasm, Pain
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Malignant lymphomas (narrow), Haematological malignant tumours (narrow), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 92
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 5/19, there were two lumps grew on his left neck. He visited his family doctor on 6/2, and some exams were done. He got the exam report on 6/3. It showed that his hemoglobin dropped to around 12, and he is severely dehydrated. Second Covid shot on 6/6/2021, 2 weeks later, he couldn''t walk any more due to weakness and pain, around 6/21/2021. He went to the family doctor on 7/7, and did more test. His hemoglobin dropped to around 11 as the result showed on 7/8. He was sent to the emergency room at Hospital on 7/14. He found 1 lump in his brain and he was admitted to the hospital immediately. He was diagnosed lymphoma. There was no treatment. He was transferred on 7/15. They found 3 lumps in his brain. There was no treatment. He was then diagnosed Goblet Cell Adenocarcinoma. He was then transferred on 7/15 at 3am. He had open skull surgery on 7/28, and there 7 tumors in his brain, 1 in his right eye, and numerous in his body. No treatment. He passed away on 8/19.


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