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

This is VAERS ID 1180565



Case Details

VAERS ID: 1180565 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-01
Onset:2021-04-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Death, Feeling of body temperature change, Hyperhidrosis, Musculoskeletal stiffness, Peripheral coldness, Staring, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chemotherapy
Current Illness:
Preexisting Conditions: Stage 1 Cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare. Date of death 04/07/2021.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180565

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