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

This is VAERS ID 1347211



Case Details

VAERS ID: 1347211 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-26
Onset:2021-04-18
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xalatan, Neurontin, Vitamin D, Acetaminophen, Mirapex, Levodopa, carbidopa, Lexapro, Cetaphil cream, Dialogistic.
Current Illness: Unknown.
Preexisting Conditions: Skin cancer, hypotension, convulsions, Alzheimer, respiratory problems, glaucoma, vitamin D deficiency, Parkinson, heart attack, mayor depression.
Allergies: Unknown.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dies at the Hospital do to a respiratory arrest.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1347211

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