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

This is VAERS ID 886926



Case Details

VAERS ID: 886926 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2020-09-21
Onset:2020-09-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER Q20200604 / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. S020307 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CN0095075132009CHN009056

Write-up: death; This spontaneous report was received from an unspecified reporter via Center for Disease Control and Prevention (CDC) concerning to a 87 years old male patient. The patient''s medical history, concurrent conditions and concomitant therapies were not provided. On 21-SEP-2020, he was vaccinated with one dose of Pneumococcal Vaccine, Polyvalent (23-valent) (PNEUMOVAX) (lot#S020307, expiry date: 24-JAN-2021) and influenza virus vaccine (unspecified) (lot# Q20200604, expiry date: 08-JUN-2021) (strength, dose and route were not provided for any suspect therapy). On the same date before 6pm, he died. The cause of death as well as was if an autopsy was performed were unknown. The causal relationship between the patient''s death and the suspect therapy was not provided. Lot investigation was initiated due to patient''s death.


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