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From the 10/8/2021 release of VAERS data:

This is VAERS ID 995641

Case Details

VAERS ID: 995641 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: North Dakota  
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Acute myocardial infarction, Asthenia, Blood test, Computerised tomogram, Condition aggravated, Confusional state, Death, Hypotension, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor 40mg po QD, Baclofen 10mg po BID, Tylenol ES 500mg po BID, Senna-S 50/8.6mg po BID, Vitamin D3 5000 IU po QD, Multivitamin tablet po QD, Garlic Oil 1000mg po QD, Lasix 40mg po QD, Aspirin EC 81mg po QD, Metformin 500mg po QD, Lisino
Current Illness: No active illnesses at time of vaccination or 1 month prior to vaccination; was diagnosed with UTI between vaccination and date of death.
Preexisting Conditions: Malignant neoplasm of prostate, Hypothyroidism, Type 2 Diabetes Mellitus, Hyperlipidemia, Multiple Sclerosis, Neuropathy, Essential primary hypertension, Atrial Fibrillation, Heart Failure, Peripheral Vascular Disease, Constipation, Weakness, Dry mouth, Personal history of Urinary Tract Infections
Allergies: NKA
Diagnostic Lab Data: Non contrast CT Multiple different laboratory blood tests
CDC Split Type:

Write-up: Resident was hospitalized for confusion, and hypotension and increased weakness; resident proceeded to have a NSTEMI and died on 5th day in hospital on 1/31/2021.

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