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From the 1/14/2022 release of VAERS data:

This is VAERS ID 987469

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Case Details

VAERS ID: 987469 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Pennsylvania  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram abdomen, Computerised tomogram abnormal, Culture negative, Diarrhoea, Lung opacity, Pneumonia aspiration, Respiratory rate increased, Urine analysis normal, Vomiting
SMQs:, Acute pancreatitis (broad), Interstitial lung disease (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: was being treated with antibiotic prednisone for hand swelling day prior
Preexisting Conditions: history of bowel obstructions and diverticulosis, AFIB, Dementia, PANCYTOPENIA
Diagnostic Lab Data: Per hospital report CXR- aspiration pneumonia, UA C&S - all negative, CT of abdomen and pelvis showing some bibasilar airspace opacities and atelectasis. possible evidence of enterocolitis symptoms may also be secondary to immune response to second COVID 19 vaccination.
CDC Split Type:

Write-up: emesis bright yellow in color, liquid BM, increased respirations

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