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

This is VAERS ID 1059048



Case Details

VAERS ID: 1059048 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-22
Onset:2021-02-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Death, Fatigue, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg once daily, lorazepam 1 mg two tablets once daily, metoprolol er succinctness 100 mg once daily
Current Illness: None
Preexisting Conditions: Long QT Syndrome Atrial fibrillation
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, fatigue, muscle aches, nausea, death 48 hours after injection


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1059048

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