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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1362465



Case Details

VAERS ID: 1362465 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-26
Onset:2021-05-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin
Current Illness: nil
Preexisting Conditions: diabetes
Allergies: nil
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest pain, fatigue, death


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1362465

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