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

This is VAERS ID 1172620



Case Details

VAERS ID: 1172620 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-03-04
Onset:2021-03-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Fatigue
SMQs:

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: Stopped regular medications day of vaccination as instructed.
Current Illness: None
Preexisting Conditions: Exercise induced asthma, migraine, repaired mitral valve prolapse 20 years prior. Transient global amnesia treated with seizure medication, no breakthrough in 7-10 years. Repaired skull fracture from fall 2019. Essential tremor.
Allergies: Lactose and gluten intolerance
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: My father, who at 80 was walking 2 miles a day and had just had a check up within the month consisting of an MRI, cardiac monitor and lab work which gave him essentially a clean bill of health felt fatigued after his second Moderna shot. 11 days after his second dose he took an afternoon nap and was found dead by my mother and myself. We are devastated. The time frame so close to his second moderna shot can not be ignored. We want no one to suffer a loss such as this if the vaccine was a catalyst. Full autopsy is ongoing, no know cause with initial results.


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