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From the 4/30/2021 release of VAERS data:

This is VAERS ID 988369



Case Details

VAERS ID: 988369 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-19
Onset:2021-01-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pneumonia aspiration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol Citalopram Phenytion Olanzapine
Current Illness:
Preexisting Conditions: diabetes gastroparesis MitraClip
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: aspiration pneumonia/death


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=988369


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