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From the 9/17/2021 release of VAERS data:

This is VAERS ID 998228



Case Details

VAERS ID: 998228 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-29
Onset:2021-02-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: ALBUTEROL HFA (8.5GM) 90 MCG INHA TAKE 1-2 PUFFS INHALATION EVERY 4 TO 6 HOURS AS NEEDED APAP 325MG TABS one (1) to two (2) tabs By Mouth two times daily as needed CALCIUM CARB (150) 500 MG CHEW TAKE 1-2 TABS BY MOUTH THREE TIMES DAILY AS
Current Illness: COPD Gastro-espohageal reflux Osteoarthritis Essential Hypertension Dermatitis COVID-19
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found unresponsive


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