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

This is VAERS ID 1369287



Case Details

VAERS ID: 1369287 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-31
Onset:2021-04-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027D21A / 2 AR / IM

Administered by: School       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest, Chest pain, Chills, Fatigue, Headache, Sudden cardiac death, Toxicologic test normal, Vaccination complication
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   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: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None known.
Diagnostic Lab Data: Autopsy showed no anatomic cause of death; toxicology non-contributory. Suspect possible undiagnosed underlying genetic arrhythmia syndrome. Parents suspect a vaccine-related death.
CDC Split Type:

Write-up: Sudden cardiac death. After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1369287

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