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

This is VAERS ID 1336774



Case Details

VAERS ID: 1336774 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-26
Onset:2021-05-13
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Cellcept, prednisone and cyclosporine
Current Illness: Hx of double lung transplant in 2005 (chronic rejection) and ERSD on hemodialysis
Preexisting Conditions:
Allergies: Codeine, Morphine, Percocet
Diagnostic Lab Data: SARS CoV-2 PCR 5/13/21 Positive
CDC Split Type:

Write-up: Patient developed fever, dyspnea and headache on 5/12/2021; tested positive for COVID-19 on 5/12/2021; patient died on 5/20/21


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1336774

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