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From the 5/7/2021 release of VAERS data:

This is VAERS ID 1109350

Case Details

VAERS ID: 1109350 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   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: codeine-guafenesin, omeprazole, tizanidine, duloxetine, doxepin, ondansetron, amlodipine, fluticasone-salmeterol, monteleukast, ropinirole, simvastatin, cetirzine, bupropion, buspirone, methotrexate, oxycodone, loperamide, ergocalciferol
Current Illness: admission 2/28-3/1 for chronic cough, recent sob, chest pain. evaluation at that time including CTA chest, cardiac stress test unremarkable. further outpatient evaluation for the cough was pending.
Preexisting Conditions: GERD, HTN, DM, HLD, Bipolar, PMR, RA, asthma
Allergies: adhesive, aluminum-magnesium hydroxide, dicloxacillin, ketorolac, lidocaine, penicillin, povidone-iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: unexplained death on 3/15/21

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