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From the 3/26/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 1122468



Case Details

VAERS ID: 1122468 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-02-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away unrelated to covid vaccine Narrative: The patient had prostate cancer, Merkle cell carcinoma and clear cell carcinoma of kidney. Patient has been placed on hospice care. Patient received the first dose of Pfizer on 2/1 and no adverse reaction was reported. Patient passed away on 2/5. No indication that death was related to COVID 19 vaccination.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210326&IDNUMBER=1122468

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