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

This is VAERS ID 1028596



Case Details

VAERS ID: 1028596 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-02-10
Onset:2021-02-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041220A / 2 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood glucose increased, Death, Fatigue, Hypersomnia, Somnolence
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin, cardizem, aggrenox, potassium, aspirin 81mg, zofran 4mg, trimethoprim, gabapentin, colon health, AREDS, biotin, gas-x, tylenol, vitamin D3
Current Illness:
Preexisting Conditions: diabetes, arthritis, PVC''s, macular degeneration, diseased colon, thyroid partially removed
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: *extreme* fatigue. could not awaken for more than few seconds. When briefly awake she was coherent and not confused. slept deeply from 4pm and could not wake to eat or drink. No fever, bp normal, blood oxygen ok. Blood sugar at 11pm was 230. Gave her 15u lantus at 11pm (normally 25u). Was sleeping at 2:30am but had died at next check at 3:30am.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1028596


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