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

This is VAERS ID 1229034



Case Details

VAERS ID: 1229034 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8729 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid, Cardiac failure, Dyspnoea, Fatigue, Full blood count, Sepsis, Urinary tract infection, Urine analysis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: DIGOXIN TAB 0.125MG 125MCG TABS 1 TAB ONCE DAILY *HOLD IF HR < 60* [Equiv To: LANOXIN] Schedule: DAILY AT 08:00 Orig Date: 25-Mar-2021 RX: 494372 Date Written: 25-Mar-2021 EUCERIN LOT LOTN (1) APPLY TOPICALLY TO AFFECTED AREAS AS NEEDED DR
Current Illness: UTI and Sepsis were DX just after and hospitalized Heart Failure A-Fib Anemia Type II DS Hypertension
Preexisting Conditions: CA
Allergies: None
Diagnostic Lab Data: Lactic acid, CBC, U/A
CDC Split Type:

Write-up: Pt. had hx of SOB prior to vaccination and Dx with hear failure Woke up day after vaccination with being very tired. Admitted to hospital with UTI, Sepsis


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229034

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