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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1753844

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Case Details

VAERS ID: 1753844 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-04
Onset:2021-03-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   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: No
Current Illness: Diabetes, Type II, Uncontrolled - 1995 HTN/Hyperlipidemia-2002 Coronary Artery Disease (CAD) - 2002 Cerebrovascular Accident (CVA) - Lt Post Medullary Infarct 5/2008. Left leg is more weaker than right. moderate persistent asthma, Peripheral Vascular Disease (PVD) Retinopathy - (2005) 2015: proliferative retinopathy OU Neuropathy - 2002 Kidney Stones, GERD/HH/Dysphagia Prostate cancer - (7/26/2016) Tx: Radical prostatectomy 9/16/2016 Urinary incontinence - (2016) Acute renal failure - (1/24/2017) GB stone - (5/7/2017) Sleep apnea on Cpap - (2001) Influenza B infection - (11/23/2017) Lumbar epidural fibrosis s/p spine stimulator trial - (11/28/2017)
Preexisting Conditions: Above
Allergies: No
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death


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