From the 12/27/2024 release of VAERS data:

This is VAERS ID 937773

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Case Details

VAERS ID:	937773 (history)
Form:	Version 2.0
Age:	85.0
Sex:	Male
Location:	Kansas

Vaccinated:	2021-01-02
Onset:	2021-01-02
Days after vaccination:	0
Submitted:	0000-00-00
Entered:	2021-01-12

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	EJ1686 / 1	LA / IM

Administered by: Senior Living Purchased by: ?
Symptoms: Haematuria
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-03
Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 positive on 11/30/2020
Preexisting Conditions: Parkinson''s Disease, Diabetes, Heart disease, A-fib, Hypothyroidism
Allergies: Baclofen, PCN, Ambien, Singulair
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was sent to the ED due to significant hematuria. He was afebrile.

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