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

This is VAERS ID 1427108



Case Details

VAERS ID: 1427108 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-24
Onset:2021-03-16
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus, heart disease
Preexisting Conditions: Diabetes mellitus, heart disease, immune suppressed, kidney transplant 5 years prior
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR test collected 3/19, another positive COVID-19 PCR collected 3/22
CDC Split Type:

Write-up: COVID symptoms began 3/16, positive test 3/19, hospital admission 3/22, death 4/1


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1427108

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