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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1237530

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Case Details

VAERS ID: 1237530 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BLOOD THINNING, THYROID, HYPERTENSION
Current Illness: NONE
Preexisting Conditions:
Allergies: PENICILLIN AND GARLIC
Diagnostic Lab Data: At age 91 we did not do an autopsy
CDC Split Type:

Write-up: Mom was feeling fine the day of the vaccine. Last spoke with her at 6:30 PM and she said she wasn''t feeling anything but would go to bed early. I said OK I will check on you in the morning. She never woke up!


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