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

This is VAERS ID 1053322



Case Details

VAERS ID: 1053322 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-29
Onset:2021-01-31
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 30
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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had passed away before second dose


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1053322

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