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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1006029



Case Details

VAERS ID: 1006029 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-14
Onset:2021-01-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7108NA / 6 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin
Current Illness: none
Preexisting Conditions: expressive language delay
Allergies: none
Diagnostic Lab Data: I do not have records from the ED to know what they did
CDC Split Type:

Write-up: Patient had a syncopal event at night about 2 1/2 weeks after vaccination. He was found unresponsive the next morning and taken to ER, where he could not be revived.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1006029


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