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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1038147



Case Details

VAERS ID: 1038147 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-28
Onset:2021-01-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Cerebrovascular accident, Death, Intensive care
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, propranolol, levothyroxine
Current Illness: None
Preexisting Conditions: Hypertension, hypothyroidism
Allergies: Sulfa drugs
Diagnostic Lab Data: Admitted to the hospital Monday 2/1. Received 24 hours of ICU care, then transitioned to comfort measures. Passed away 2/11
CDC Split Type:

Write-up: Patient went into new-onset atrial fibrillation, resulting in a catastrophic stroke. Patient passed away on 2/11 as a result of the stroke.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1038147

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