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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1027158



Case Details

VAERS ID: 1027158 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-10
Onset:2021-02-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Malaise, Muscular weakness, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), 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: 2021-02-12
   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: acetaminophen 500 mg oral tablet, 500 mg= 1 tabs, Oral, TID, 1 refills ammonium lactate 12% topical lotion, 1 app, Topical, BID, 2 refills calcium (as carbonate)-vitamin D 600 mg-400 intl units oral tablet, 1 tabs, Oral, BID, 4 refills C
Current Illness: CKD-4 Dementia Incontinence of stool Insomnia Skin breakdown right gluteus
Preexisting Conditions: Chronic insomnia CKD Constipation Dementia Hepatitis B non-immune Onychomycosis Osteoporosis NOS Stool incontinence x2 ( 2 months and one week ago while out on stret) TIBC - Total iron binding capacity low Tinea pedis Vitamin B12 deficiency Vitamin D deficiency
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: death. Per son pt was not feeling well after the vaccination "like her legs were weak." Son found the mom in her bed 1am on 2/12/2021 unresponsive.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1027158


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