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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1362534



Case Details

VAERS ID: 1362534 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-27
Onset:2021-01-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Aortic aneurysm repair, Blood pressure increased, Blood test, Computerised tomogram thorax abnormal, Condition aggravated, Death, Device dislocation, Hypertension, Pneumonia, X-ray
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 121
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 78 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastin 40 mg metoprolol 50 mg linzess 145 micrograms 1xday levophroxine 50 mcg tamsulosin 0.4 mg 1xday hydroalazine 100 mg every 6 hrs as need for bp zetia 10 mg daily losorthn 50 mg daily bumetanide 1 mg daily coQ10 vit-C aspirin 325
Current Illness: cold possibly in November or December
Preexisting Conditions: stage 3 kidney disease hypertension
Allergies: no
Diagnostic Lab Data: CT scan that showed the aneurysm was expanding and the graft had broken loose. x-rays blood work
CDC Split Type: vsafe

Write-up: Within 24 hours after the vaccine his blood pressure escalated out of control, 200''s over 100''s . He went to see his PCP and cardiologist Nephrologist ended up in the hospital in February and his aortic graphic had broken loose and they felt it was because of the escalation of the blood pressure which the doctor felt was a possibility caused by the vaccine. February 7 he was in the hospital for 4 days. On march 10 he went to the hospital to repair the aneurism that had broken loose, the doctor thought it could have broken loose from the hypertension of the blood pressure. He stayed in the hospital for 48 day and was transferred to a rehab center in anther hospital he was in the hospital for a total of 78 days . He came home on the 26 of May and had home health care, he also was ended up with pneumonia. he came home on antibiotics . He ended up passing away yesterday, May 30th, 2021


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