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

This is VAERS ID 1230079



Case Details

VAERS ID: 1230079 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-19
Onset:2021-03-27
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: Tramadol 50Mg once a day,losartan 50mg one a day,magnesium oxide 400 mg once a day, mirtazapine 7.5 mg one a day, multuvitamin, pantoprazole 40mg twice a day sertraline 50 mg one a day, sortaol 80mg half in the morning half at night, vitami
Current Illness: Was in the hospital on January 31 had a brain bleed. Was there for two weeks. From there he went into a nursing home for rehab. He got his first shot on February 19 2021 and the second one on March 19, 2021. He passed away on March 27,2021
Preexisting Conditions: mild copd,had a brain bleed almost 8 years before this last one.
Allergies: Penicillin, morphia,sulfur,codeine, chlorhexidine gluconate,sulfadiazine.
Diagnostic Lab Data: No, not sure it has anything ti do with his death, just reporting it.
CDC Split Type:

Write-up: My husband passed away two weeks and one day after getting his last vaccine


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230079

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