From the 4/26/2024 release of VAERS data:

This is VAERS ID 925264

Government Disclaimer on use of this data

Case Details

VAERS ID:	925264 (history)
Form:	Version 2.0
Age:	77.0
Sex:	Male
Location:	Oklahoma

Vaccinated:	2020-12-31
Onset:	0000-00-00
Submitted:	0000-00-00
Entered:	2021-01-07

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA	025L20A / 1	LA / IM

Administered by: Other Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco 5/325 1 tablet every 6 hours as needed. Warfarin 4mg , 2 tablets orally Monday and Friday Torsemide 100mg, 1/2 tablet orally once a day Sabcubitril-Valsartan 24/26mg 1/4 tablet orally twice a day Gabapentin 300mg, tablet once daily Ca
Current Illness: CHF HTN DM 2 CKD Obesity DDD
Preexisting Conditions: CHF HTN DM 2 CKD Obesity DDD
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: PT was found deceased in his home on 1/5/2021

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