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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1326488



Case Details

VAERS ID: 1326488 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-23
Onset:2021-05-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Death
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None reported
Preexisting Conditions: Hypertension Diabetes Anemia
Allergies: None reported
Diagnostic Lab Data: Unknown. Medical Records at healthcare facility.
CDC Split Type:

Write-up: May 3, 2021, received a call from healthcare provider where the vaccine was given by healthcare provider. COVID 19 Prescreening Form Completed and Vaccine given 4/23/2021. Patient waited 15 minutes post vaccination no reaction. Her family also received a vaccine. Daughter and Son-In Law. Received a call that patient had died on 5/2/2021. Presented to healthcare facility for chest pain according to healthcare provider.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1326488


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