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

This is VAERS ID 1041064



Case Details

VAERS ID: 1041064 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-04
Onset:2021-02-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   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:
Current Illness:
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: CLIENT EXPIRED 1 WEEK FOLLOWING THE VACCINE.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1041064

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