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

This is VAERS ID 1501811



Case Details

VAERS ID: 1501811 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-22
Onset:2021-07-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   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: Lisinopril 40mg daily
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day of injection patient was experiencing fever and chills, also had sore arm. 2 days after the injection the patient was found dead


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1501811

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