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From the 11/26/2021 release of VAERS data:

This is VAERS ID 965807

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Case Details

VAERS ID: 965807 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-08
Onset:2021-01-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Immobile, Pruritus, Respiratory disorder, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-16
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol, methotrexate, calcitrol, digoxin, calcium prednisone, clopidogrel, levothyroxine, folic acid, pantoprazole, eliquis, atorvastatin, latanoprost, melatonin
Current Illness: nose bleeds
Preexisting Conditions: rheumatoid arthritis, atrial fibrillation
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: began itching within 24 hours, within 5 days couldn''t move on her own, by 6th day was having respiratory issues, by day 7 unresponsive, by day 8 dead


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