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From the 4/30/2021 release of VAERS data:

This is VAERS ID 377750



Case Details

VAERS ID: 377750 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2010-01-14
Onset:2010-01-16
   Days after vaccination:2
Submitted: 2010-01-21
   Days after onset:5
Entered: 2010-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 102148P1 / 1 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Coronary artery disease, Death
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-16
   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: ASA; Lisinopril 20mg; PLAVIX; Simvastatin 40mg; NITROQUICK; Metoprolol 25mg; albuterol
Current Illness: F/up HTN
Preexisting Conditions: HTN; Hyperlipidemia; Coronary atherosclerois
Allergies:
Diagnostic Lab Data: scheduled CMP, Lipid panel - Not done
CDC Split Type:

Write-up: Death apparent heart attack 1/16/10. Pt. w/ CAD/ angioplasty 7/09 w/ stent placement. On multiple meds, smoker, denied symptoms 1/14/10.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=377750


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