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

This is VAERS ID 1431502



Case Details

VAERS ID: 1431502 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-04
Onset:2021-06-26
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: interstitial lung disease along with multiple heart issues
Preexisting Conditions: interstitial lung disease along with multiple heart issues
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient died of complications due to COIVD-19 illness, which was 4 months after receiving his second dose of vaccine. He was a breakthrough case that died with full vaccination status for COIVD-19. No one is indicating that the vaccine had anything to do with this persons'' death.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1431502

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