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

This is VAERS ID 1175722

Case Details

VAERS ID: 1175722 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol sulfate HFA 90 mcg/actuation aerosol inhaler INHALE 2 PUFFS BY MOUTH EVERY 4 HOURS AS NEEDED azithromycin 250 mg tablet TAKE 2 TABLETS ON DAY 1 AND THEN 1 TABLET DAILY FOR THE NEXT 4 DAYS BD Alcohol Swabs cholecalciferol (vi
Current Illness:
Preexisting Conditions: COPD, Generalized anxiety disorder
Allergies: acetaminophen respiratory distress Reaction: Shortness Of Breath; alendronate sodium abdominal pain aspirin Bupropion facial swelling Reaction: Swelling; codeine cyclobenzaprine anaphylaxis Reaction: Anaphylaxis; Flexeril anaphylaxis Reaction: Anaphylaxis; gabapentin anaphylaxis Reaction: Anaphylaxis; Haldol nitrofurantoin NSAIDS (Non-Steroidal Anti-Inflammatory Drug) facial swelling Reaction: Swelling; Penicillins respiratory distress Reaction: Shortness Of Breath; pseudoephedrine other Reaction: Unknown; Serotonin 5HT-3 Antagonists Varoius reactions strawberry rash Reaction: Rash; strawberry extract rash, mild Reaction: Rash;Severity: Mild; Sulfa (Sulfonamide Antibiotics) facial swelling Reaction: Swelling; Symbicort tomato respiratory distress Reaction: Shortness Of Breath; tramadol facial swelling Reaction: Swelling; Tricyclic Compounds Tylenol respiratory distress, severe Reaction: Shortness Of Breath;Severity: Severe; valacyclovir wheezing, moderate Wellbutrin facial swelling, severe Reaction: Swelling;Severity: Severe
Diagnostic Lab Data:
CDC Split Type:

Write-up: Family member reported patient deceased. Was found on 3/21/21. She had told a friend she wasn''t feeling well on the night of 3/19/21.

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