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

This is VAERS ID 1116408



Case Details

VAERS ID: 1116408 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-02-02
Onset:2021-02-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Heart rate increased, Hepatic failure, Hypotension, Internal haemorrhage, Oxygen saturation decreased, Pericardial effusion, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Warfarin
Current Illness:
Preexisting Conditions: A-VIB
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severe internal bleeding fluid build up around lungs/heart high heart rate low blood pressure low oxygen liver failure death


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1116408

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