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

This is VAERS ID 1081305



Case Details

VAERS ID: 1081305 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-02-26
Onset:2021-02-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

Administered by: Military       Purchased by: ?
Symptoms: Autopsy, Cardiac disorder, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death approximately 24 hours after receiving 2nd COVID vaccine - symptoms unknown - autopsy revealed cardiac disease as the cause of death


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1081305

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