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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1169011



Case Details

VAERS ID: 1169011 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: one friend got COVID after the shot and has passed away; A spontaneous report was received from a consumer concerning a female patient of an unknown age who received Moderna''s COVID-19 vaccine and got COVID after the shot and has died/COVID-19. The patient''s medical history was not provided. Concomitant product use was not provided by reporter. On an unknown date the patient received their first of two planned doses of mRNA-1273 (Batch number not provided) for prophylaxis of COVID-19 infection. Reporter mentioned that her friend got COVID after the shot and has died. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event death is not applicable. The patient died on an unknown date. The cause of death was not provided. Plans for an autopsy were not provided.; Reporter''s Comments: A case of death of female patient of an unknown age who developed COVI on an unknown date post mRNA-1273 (vaccination (lot unknown) and died. Very limited information regarding this event/s has been provided at this time. However, based on the known etiology of COVID and the established profile of mRNA-1273, the event is assessed as unlikely related to mRNA-1273 administration. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


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