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

This is VAERS ID 987533

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Case Details

VAERS ID: 987533 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: California  
   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: Death, Full blood count, Lethargy, Metabolic function test
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   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: Insulin Lispro, Propranolol 120mg, Clopidogrel 75mg, Donepezil 10mg, Memantine 10mg, QUEtiapine Fumarate 100mg, Pantoprazole 40mg, Pramipexole Dihydrochloride 1.5mg, predniSONE 20mg, Aspirin 81mg, Atorvastatin Calcium 40mg, Insulin Glarg
Current Illness: See item 12
Preexisting Conditions: COPD, CHF, DM, Asthma, HTN, Dementia, Depression, GERD, Parkinson
Allergies: Dexamethasone, Versed
Diagnostic Lab Data: Stat CBC & CMP ordered. Labs were drawn but the patient expired before the facility received the results.
CDC Split Type:

Write-up: The patient was observed to be lethargic on 1/29/21 at 1515. BP-80/50, P-75, RR-27, T-100.1. He was given a bolus of NS 150 mlx2. and Rocephin 1 gram IM.

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