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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1000709

Case Details

VAERS ID: 1000709 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Death, Pleural effusion
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: amiodarone, ASA, calcitriol, coreg, folvite, apresoline, synth
Current Illness: see below
Preexisting Conditions: see below
Allergies: Heparin, Amoxcillin
Diagnostic Lab Data: Patient was hospitalized related to multiple chronic diagnoses.
CDC Split Type:

Write-up: Patient with past medical history of CAD, CKD, sCHF, LGL Leukemia admitted to Hospital on 1/19 with pleural effusion. Pt expired on 2/1/2021. Hs of essential HTN, complete heart block, T2Diabetes,thyroid issues, stroke, papillary CA of thyroid, dyslipidemia, anemia, hypercalcemia, pulmonary nodule, hypoparathyroidism, pacemaker, bilat carotid stenosis, afib, pleural effusion, pancytopenia, cardiomyopathy, severe aortic stenosis, sick sinus syndrome, Dressler syndrome, empyema, ESRD

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