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

This is VAERS ID 992677



Case Details

VAERS ID: 992677 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-01-26
   Days after vaccination:1
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: Back pain, Body temperature increased, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonazepam, Mirtazapine, Seroquel, Austedo, Risperdal, Senna, Omeprazole
Current Illness:
Preexisting Conditions: Huntington''s Anxiety, Depression, Constipation.
Allergies: Paroxetine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low Grade Temp, Persistent low back pain, Projectile Vomiting.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=992677


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