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From the 1/7/2022 release of VAERS data:

This is VAERS ID 961705

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Case Details

VAERS ID: 961705 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   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: Phenergan, melatonin, clonazepam, vit d, asorbic acid, zinc, cholecalciferol, lomotrigine, cimetadine, quetiapine,
Current Illness: none
Preexisting Conditions: Frontotemporal dementia, copd, type 2 diabetes with kidney disease, Anxiety, Atherosclerotic heart disease, covid 19 on 10/15/2020
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: approximately 3 hours prior to expiring the patient was experiencing forceful emesis. later was found to have expired, patient was comfort care only.

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