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

This is VAERS ID 930154

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Case Details

VAERS ID:	930154 (history)
Form:	Version 2.0
Age:	60.0
Sex:	Male
Location:	Ohio

Vaccinated:	2021-01-05
Onset:	2021-01-08
Days after vaccination:	3
Submitted:	0000-00-00
Entered:	2021-01-08

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA	039K2020A / 1	LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
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: unknown
Current Illness: unkown
Preexisting Conditions: unknown
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type: VFC # 21109

Write-up: Notified today that he passed away. No other details known at this time.

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