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

This is VAERS ID 1063681



Case Details

VAERS ID: 1063681 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-01-27
Onset:2021-02-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Triam/HCTZ, Omeprazole
Current Illness: none
Preexisting Conditions: Mild hypertension, GERD
Allergies: none
Diagnostic Lab Data: None. no Autopsy was done
CDC Split Type:

Write-up: Pt got his vaccine 1/27 and was found dead at his residence on 2/7/21. I heard from our county health officer who talked to the coroner who said that they estimated that the patient had been deceased for 2-3 days prior to when they were found. No apparent cause of death was found.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1063681

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