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

This is VAERS ID 1338617



Case Details

VAERS ID: 1338617 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011AZ1A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Metformin Hydrochloride, Flomax, Diltiazem, Ferrous Sul, Lipitor, Tramadol.
Current Illness: N/A
Preexisting Conditions: Diabetes, a-fib, obesity.
Allergies: N/A
Diagnostic Lab Data: No tests performed following death.
CDC Split Type:

Write-up: Death of patient two days after second injection.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1338617

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