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From the 7/16/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 861839



Case Details

VAERS ID: 861839 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2020-01-14
Onset:2020-02-08
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2020-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 AR / SYR

Administered by: Pharmacy       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? Yes
Birth Defect? No
Died? Yes
   Date died: 2020-03-29
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cellcept, pyridistigmine, omeprazole, Levo dopa, carbidopa
Current Illness: Week previous to incident, stomach illness, vomiting
Preexisting Conditions: Parkinsons, Myasthenia Gravis
Allergies: penicillin, levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Onset of seizure, hospitalized, stabilized, seizure return, given Keppra, stabilized, returned again


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210716&IDNUMBER=861839

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