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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1032252



Case Details

VAERS ID: 1032252 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-07
Onset:2021-01-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MetFORMIN HCl Tablet 500 MG bid with meals GlipiZIDE Tablet 5 MG bid ac meals PROSTAT SUGAR FREE 30cc tid ROBITUSSIN DM 10ml q4hrs prn Lipitor Tablet 10 MG (Atorvastatin Calcium qd at 5pm NX: DIABETIC ICE CREAM (EXTRA DESSERT) two times a
Current Illness: Loss of appetite and generalized body weakness
Preexisting Conditions: DM Type 2
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident tested COVID-19 confirmed positive a few days after covid vaccination.


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