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

This is VAERS ID 1179434



Case Details

VAERS ID: 1179434 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-01
Onset:2021-03-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Blood glucose increased, Feeling abnormal, Influenza like illness, Mydriasis, Myocardial infarction, Nausea, Pain, Pallor
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: None
Preexisting Conditions: Diabetes & muscular sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She felt. Ad the evening of her 2nd vaccine. The morning after she felt worse. Nauseous, pale, achy. She said she had not ever felt that bad. I read possible side effects. It said flu like symptoms, so we thought it would pass. Then around 4 she called for me & when I got there she had an event that caused her to be unable to speak & her eyes widened & pupils were dilated. I called 911. They got here quick. She had at least three of those stiffening wide eyed events. The emt said they thought it was her blood sugar. When checked it was 350 even though she had taken her insulin that day. They said she had a massive heart attack on the way to the hospital.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1179434

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