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

This is VAERS ID 1368651



Case Details

VAERS ID: 1368651 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-16
Onset:2021-02-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Illness, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT APPLICABLE
Current Illness: PHARMACY DOES NOT HAVE PATIENT PROFILE. Patient fills prescription at a different pharmacy
Preexisting Conditions: patient did not list any chronic conditions on consent form
Allergies: pharmacy does not have any documented allergies for the patient
Diagnostic Lab Data: none on file at the pharmacy
CDC Split Type:

Write-up: Patient''s daughter came to the pharmacy today and said patient died of a heart attack. Patient thought that she was sick from the vaccine. Did not get help until five days after


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368651

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