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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1759083

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Case Details

VAERS ID: 1759083 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: HEADACHES
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: DEATH CERTIFICATE SAYS HEART ATTACK... STATED COULD HAVE BEEN BLOOD CLOTS
CDC Split Type:

Write-up: SON REPORTED THAT PATIENT DIED 2 DAYS AFTER GETTING THE VACCINE


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