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From the 5/7/2021 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 929359

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Case Details

VAERS ID: 929359 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Breath sounds abnormal, Death, Oxygen saturation decreased
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-08
   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: none
Current Illness: Cerebral Atherosclerosis, malnutrition, thrombocytopenia, cva, hypothyroidism
Preexisting Conditions: Cerebral Atherosclerosis, malnutrition, thrombocytopenia, cva, hypothyroidism
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 3:07 pm lung sounds diminished oxygen sats 68%, oxygen applied Oxygen sats remained low for next 36 hours ( patient on Hospice care ) expired 6:22 am 1-8-21

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