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

This is VAERS ID 844360

Case Details

VAERS ID: 844360 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Illinois  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2019-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Areflexia, Asthenia, Diarrhoea, Guillain-Barre syndrome, Immunoglobulin therapy, Mechanical ventilation, Muscular weakness, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2019-10-28
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: NONE LISTED
Preexisting Conditions: Constipation, Degenerative Joint Disease, Chronic pain, Peripheral Arterial Occlusive DiseaseAllergies: NKA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient experienced neck pain and diarrhea which then progressed to weakness. On 10/16/19 daughter drove to hospital. Patient was transferred to Medical Center. Patient with weakness starting in lower extremities, then upper extremities, areflexic bilateral upper and lower. Dx w/Guillain-Barre Sysndrome. Patient on ventilator support and receiving immunoglobulin

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