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From the 5/7/2021 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 1154126

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Case Details

VAERS ID: 1154126 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diabetic ketoacidosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Gastroparesis (Verbatim: Gastroparesis); Type I diabetes mellitus (Verbatim: Type 1 Diabetes); Ulcer (Verbatim: Ulcer)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021331199

Write-up: Diabetic ketoacidosis; This is a spontaneous report from a contactable consumer. A contactable consumer reported for her nephew. A 33-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (at the age of 33-years-old) at single dose for covid-19 immunisation. Medical history included type 1 diabetes mellitus from an unknown date and unknown if ongoing, impaired gastric emptying from an unknown date and unknown if ongoing, ulcer from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced diabetic ketoacidosis on an unspecified date. The patient died on 21Mar2021 due to diabetic ketoacidosis. An autopsy was not performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Diabetic ketoacidosis


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