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From the 3/11/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 1087735



Case Details

VAERS ID: 1087735 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-02-18
Onset:2021-03-05
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Respiratory tract congestion, Weight increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   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: Medications received day of dose 2 (2/18/21)vaccination: abilify 20mg, benztropine mesylate 2mg, celexa 40mg, clonazepam 2mg, Aricept 10mg, lactulose 30ml, synthroid 75mcg, Pepcid 20mg, Risperdal 1mg in am and 2mg at HS, senna-s 2 tablets,
Current Illness: 12/7/20 BMP with elevated kidney function, some diuretics on hold 12/10/20 BMP with continued elevated kidney function, diuretic decreased 12/14/20 C/O body aches, rapid covid test negative, potassium adjusted based on labs 12/15/21 BMP drawn, increased weight gain. N.O. increase torsemide to 100mg PO QD, QD weights, and weekly BMP Q Monday. 12/28/20 Vomited small amount, rapid covid negative, continued with weight gain and diuretics increased. 1/7/21 Difficulties swallowing, picked up by ST and fluids change to nectar thick consistency. 1/11/21 Drowsy and weak with low CBGs. Dieuretic put on hold 1/12/21 Low temperature and low CBG 1/13/21 All diuretics put on hold. N.O. nephrology consult for advancing CKD & explore if dialysis is an appropriate options. Diet downgraded to all ground. 1/15/21 Had modified barium swallow and per report recommends NPO r/t aspiration. Diet changed to puree, thin liquids. 1/18/21 UA sent for C&S if indicated for / blood clots in urine. Then had congested cough. Had CXR and results showed bilateral lower lobe infiltrates and bilateral effusions. 1/19/21 Sent to ER for eval of lethargy, not eating, and acute on chronic kidney injury. Admitted to CMC. 1/31/21 Returned form hospital NPO with PEG tube, all diuretics D/C. 2/1/21 Oral thrush tx 10 cc Nystatin swish and spit TID for 10 days 2/8/21 CBC/BMP with no significant acute findings 3/4/21 Increased weight and started back on diuretic torsemide 20mg. Approximately 0200 on 3/5/21 became congested. Doctor was notified with N.O. Torsemide 20 mg tab via PEG-tube NOW, IM Rocephin 1 mg QD x7 days for possible aspiration, Chest X Ray, CBC/BMP in morning, and may suction resident if tolerated PRN. 3/5/2021-0350 deceased.
Preexisting Conditions: Pneumonitis due to inhalation of food and vomit, acute kidney failure, anemia, dysphagia, malaise, weakness, cognitive communication deficient, abnormal posture, personal history of COVID19, gastrostomy statsu, vitamin D deficiency, essential tremor, chronic diastolic heart failure, muscle spasm, benign prostatic hyperplasia without lower urinary tract symptoms, gout, sleep apnea. Anxiety disoreder, atrial fibrillation, dementia with behavioral disturbance, lymphedema, epiliepsy, schizophrenia, major depressive disorder, hyperlipidemia, hypothyroidism, Essential hypertenision, drug induced subacute dyskinesia
Allergies: Codeine, Buspar, Clozaril, Geodon, Mellaril, Seroquel, Thorazine, Pineapple, Plum, Prune, Dust, Tetanus Toxin
Diagnostic Lab Data: Labs and CXR unable to be completed on day of event due to patient expired prior.
CDC Split Type:

Write-up: On 3/5/21 at approximately 0200 became congested suddenly. Doctor was notified with N.O. Torsemide 20 mg tab via PEG-tube NOW, IM Rocephin 1 mg QD x7 days for possible aspiration, Chest X Ray, CBC/BMP in morning, and may suction resident if tolerated PRN. Received both Torsemide and the Rocephin and then deceased at 0350.


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