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From the 5/7/2021 release of VAERS data:

This is VAERS ID 786304



Case Details

VAERS ID: 786304 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2018-11-07
Onset:2018-11-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2018-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 252229 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2018-11-10
   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, CARVEDILOL, FOLBEE, GLIPIZIDE ER
Current Illness: ANEMIA SECONDARY TO ABSORPTION ISSUES S/P GASTRIC BYPASS
Preexisting Conditions: TYPE 2 DIABETES; HYPERTENSION; HYPERLIPIDEMIA; KIDNEY STONES
Allergies: TRAMADOL
Diagnostic Lab Data:
CDC Split Type:

Write-up: DIED AT HOME, UNATTENDED? 11-10-2018.


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