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

This is VAERS ID 1232707



Case Details

VAERS ID: 1232707 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-09
Onset:2021-04-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute cardiac event, Death
SMQs:, Myocardial infarction (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   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: Latuda, Lexapro, Clozaril, Trazodone, Klonopin, Famotidine, Jardiance, Lisinopril, Atorvastatin, Metformin, Protonix, Basaglar
Current Illness: None known
Preexisting Conditions: T2 Diabetes Mellitus; Hypertension; High Cholesterol, Anxiety/Bipolar; Nicotine Dependence; hx of melanoma
Allergies: Cipro, Codeine, Toradol
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient died at home per medical examiner, suspected cardiovascular event


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1232707

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