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

This is VAERS ID 1088328



Case Details

VAERS ID: 1088328 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-04
Onset:2021-02-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Respiratory arrest
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: Zoloft, Donepezil, Lanoxine, Furosemide, Imdur, Cozaar, Aldactone, Coreg, Pestoril, Pepcid
Current Illness:
Preexisting Conditions: Heart Failure, Hypertension, Osteoporosis, Memory Loss
Allergies: None were reported
Diagnostic Lab Data:
CDC Split Type: Pr-52-21

Write-up: The caregivers in their rounds indicates that resident was well, ate his meals and her vitals were taken. In their next 7:30 pm rounds they find that the resident was not breathing. Home physician certifies death as Congestive Heart Failure.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088328

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