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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1123247



Case Details

VAERS ID: 1123247 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-22
Onset:2021-03-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown - did list Eliquis as being taken.
Current Illness: none noted
Preexisting Conditions: unknown
Allergies: indicated none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Our agency was alerted that the patient passed away on 3/16/2021


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1123247


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