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

This is VAERS ID 959167

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Case Details

VAERS ID: 959167 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-01-14
Onset:2021-01-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-16
   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: unknown
Current Illness:
Preexisting Conditions: Seizures were reported on vaccine form
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID 19 vaccine 01/14/2021. Patient died in his sleep 01/16/2021.


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