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

This is VAERS ID 1231568



Case Details

VAERS ID: 1231568 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac disorder, 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: Lisinopril, simvastatin, levothyroxine, ropinirole, inhaler
Current Illness: None known
Preexisting Conditions: Hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, restless leg syndrome, obesity
Allergies: None known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Unknown onset of adverse events. PT received second COVID vaccine on 3/26/21. She was found deceased in her residence (where she lives alone) by family on 3/28/21. She was found in bed, appropriately covered with blankets. Son last spoke with PT around 17:30 hours on 3/26 after receiving the vaccine, and reported the PT did not complain of any symptoms, did not sound short of breath, and did not complain of any breathing difficulty. Based on postmortem presentation, believed PT died late night of 3/26/early morning of 3/27. Suspect death is likely due to PT''s heart disease, Medical Examiner agreed with the assessment.I spoke with the clinic that administered the second dose, and was informed that the PT did not exhibit any signs/symptoms during the observation period immediately following the vaccine being given. PT''s PCP was contacted, and agreed to certify DC based on known medical history. PCP also agreed that the death did not sound related to the vaccine based on lack of symptoms as reported by the administering clinic and family.


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