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

This is VAERS ID 1362251



Case Details

VAERS ID: 1362251 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-01
Onset:2021-05-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chest discomfort, Death, Dyspnoea, Myocardial infarction, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NovolinN Lantus Plavix Lipitor Lasix Losartan Posa chloride
Current Illness: None
Preexisting Conditions: Diabetic
Allergies: None
Diagnostic Lab Data: All testing. Resulting in Death
CDC Split Type:

Write-up: Upset stomach and vomiting. Shortness of breath. Pressure in chest. Heart attack and DEATH.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1362251

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