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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1033448



Case Details

VAERS ID: 1033448 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-01-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dyspnoea, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood Thinners Pyschotropics
Current Illness: Had Covid-19 one month prior
Preexisting Conditions: Irregular Heart Asthma pneumonia prone
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever by the next day, difficulty breathing, pneumonia, and then DEATH within a few days. (Died 02/01/2021)


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1033448


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