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

This is VAERS ID 1080932



Case Details

VAERS ID: 1080932 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-01-23
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Endotracheal intubation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 11
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:
Current Illness: HYPERTENSION, COPD, NON-SMALL CELL CANCER RIGHT LUNG
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: INTUBATION 1/23/21;
CDC Split Type:

Write-up: DIAGNOSED WITH COVID 1/21/21; RECIEVED BAMLANIVUBAM INFUSION; HOSPITAL ADMISSION 1/23/21 WITH ACUT RESPIRATORY FAILURE DUE TO COVID. INTUBATED X 10 DAYS


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1080932

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