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From the 11/19/2021 release of VAERS data:

This is VAERS ID 955959

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Case Details

VAERS ID: 955959 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-01-11
Onset:2021-01-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0399K20-2A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-18
   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: alfuzosin, allopurinol. amlodipine, aspirin, Sinemet, vitamin D, multivitamin, Lexapro, finasteride, mirtazipine, ropinirole, trospium
Current Illness: recently diagnosed with progressive supranuclear palsy
Preexisting Conditions: BPH, HTN, gout, GERD, hyperlipidemia
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient died 1 week after vaccination. According to family was having very rapid decline in status in recent weeks and they did not think related to vaccination.


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