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

This is VAERS ID 1247180

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Case Details

VAERS ID: 1247180 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-17
Onset:2021-04-04
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Opiramate 50 mg/day, Escitalopram oxolate 30 mg/day, Bupropion HCL ER 300 mg/day, Alprazolam 0.25 mg as needed (2x/day)
Current Illness: none (had foot surgery -- bunionectomy -- 2 days prior to vaccine administration)
Preexisting Conditions: none (though overweight)
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away suddenly and unexpectedly at home the morning of April 4, 2021. The ER doctor was unable to ascertain a cause. The preliminary autopsy conducted by the medical examiner within 24 hours of death was inconclusive, but I''m told tests of samples are ongoing.


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