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From the 9/17/2021 release of VAERS data:

This is VAERS ID 857879



Case Details

VAERS ID: 857879 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2020-01-23
Onset:2020-01-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. UNKNOWN / UNK - / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-01-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: uncertain
Current Illness: rheumatoid arthritis
Preexisting Conditions: rheumatoid arthritis. alcohol abuse.
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: seizure within 24 hours of vaccination


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