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From the 4/23/2021 release of VAERS data:

This is VAERS ID 1001567



Case Details

VAERS ID: 1001567 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: ascorbic acid 500 mg, carbidopa-levodopa 25-100 mg, clopidogrel 75 mg, entacapone 200 mg, finasteride 5 mg, multivitamin, pravastatin, Prevident 5000 Plus 1.1%, propranolol 40 mg, rivaroxaban 20 mg, tamsulosin 0.4 mg.
Current Illness:
Preexisting Conditions: Left anterior fascicular block, hyperlipidemia, hypertension, allergic rhinitis, dysphagia, gastroesophageal reflux disease, benign prostatic hyperplasia, equinovarus deformity, toe amputation, stroke, essential tremor, parkinson''s disease, hemiplegia due to old stroke, neuropathy, spasticity.
Allergies: Hay fever
Diagnostic Lab Data: None. Coroner opted against autopsy due to age and significant comorbidities
CDC Split Type:

Write-up: Death


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