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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1036881



Case Details

VAERS ID: 1036881 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-01-11
Onset:2021-01-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple cardiac medications including anticoagulation; medications for chronic lung condition
Current Illness:
Preexisting Conditions: Chronic cardiac conditions, chronic lung. Chronic smoker
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocardial Infarction


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036881

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