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From the 3/11/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1088723

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Case Details

VAERS ID: 1088723 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-21
Onset:2021-02-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E19266 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Body temperature increased, Chest X-ray, Computerised tomogram, Death, Dyspnoea, General physical health deterioration, Intensive care, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxin, Depakote, Sertraline, Trazodone, Risperidone, Vit D3
Current Illness:
Preexisting Conditions: Down Syndrome, Autism, CKD, ITP
Allergies: Augmentin
Diagnostic Lab Data: Multiple tests were done that I no longer can access. Multiple COVID tests which were all negative, Chest x-rays, blood work, CT scan
CDC Split Type:

Write-up: Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021.


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