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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1051942



Case Details

VAERS ID: 1051942 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-11
Onset:2021-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Death, Hepatorenal syndrome
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Casodex, Sinemet CR, Plavix, Namenda, Midodrine, Protonix, Crestor, Zoloft, Trazadone,
Current Illness: Acute Hepatitis,
Preexisting Conditions: CAD, MI, RLS, Peripheral Neuropathy, PD, hyperlipidemia, orthostatic hypotension, Shy-Drager
Allergies: Intolerance to Morphine, Propoxyphene, Statins, Bisphosphonates, Tramadol, Methadone, and Meperidine
Diagnostic Lab Data: Partial autopsy. Results not complete
CDC Split Type:

Write-up: Hepatorenal syndrome- Death


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1051942

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