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

This is VAERS ID 942040



Case Details

VAERS ID: 942040 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-01-13
Onset:2021-01-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / UNK LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dizziness, Unresponsive to stimuli, Vital functions abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-13
   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: unknown
Current Illness: none
Preexisting Conditions: yes
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: little bit of a reaction light headed after 5 minutes. vitals were low, so observed for 30 minutes after being light headed. Patient was found unresponsive and pronounced dead later that day.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=942040

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