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

This is VAERS ID 1011981



Case Details

VAERS ID: 1011981 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2020-11-13
Onset:2020-11-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7049JA / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Completed suicide
SMQs:, Suicide/self-injury (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-11-13
   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:
Current Illness:
Preexisting Conditions: ADHD, Anxiety, Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suicide


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1011981


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