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From the 4/1/2021 release of VAERS data:

This is VAERS ID 991849

Case Details

VAERS ID: 991849 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-01-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041620A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Hypoxia, Respiratory tract congestion, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (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: clonazepam, Flomax, Flunisolide Soln., Melatonin, Omeprazole, Miralax, Sertraline, Milk of Mag, Tylenol
Current Illness:
Preexisting Conditions: Epilepsy, HTN, BPH, ASHD, GERD, Alzheimer''s Disease, Depression, OCD
Allergies: NKA
Diagnostic Lab Data: nonne
CDC Split Type:

Write-up: Congestion, Hypoxia, SOB, Tachycardia, Weakness. Started on O2 @ 3L, HOB elevated, Tylenol supp


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=991849


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