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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1016097

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Case Details

VAERS ID: 1016097 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Illinois  
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
   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: Amlodipine, carvedilol, clopidrogrel, cyclobenzaprine, docusate sodium, ferrous sulfate, guaifenesin, norco, insulin nph, levothyroxine, magnesium, metformin, nitrostat, rosuvastatin, spironolactone, tramadol, warfarin
Current Illness:
Preexisting Conditions: CABG-2014, CAD, HTN, hyperlipidemia, systolic murmur, type 2 diabetes, diabetic neuropathy, cervical dystonia, benign essential tremor, degenerative disc disease, intermittent claudication, PVD, former smoker-greater than 30 pack year, cervical spinal stenosis, long-term use of anticoagulant
Allergies: Hydrochlorothiazide, ACE inhibitors, Lisinopril, Valsartan, Angiotensin Receptor blockers
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died 02/08/21

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