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

This is VAERS ID 970412

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Case Details

VAERS ID: 970412 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-18
Onset:2021-01-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardio-respiratory distress, Death, Dyspnoea, Endotracheal intubation, Fatigue, General physical condition abnormal, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: thiamine 100 MG tablet sevelamer carbonate 800 MG tablet Multiple Vitamins-Minerals (MULTIVITAMIN ADULT) Tab carvedilol 3.125 MG tablet ascorbic acid 500 MG tablet lisinopril 10 MG tablet
Current Illness: High blood pressure. Dialysis
Preexisting Conditions: kidney failure, Dialysis patient
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever Feeling tired short of breath all night and morning after the vaccine My grandma had to be intubated and then passed away to a heart distress we think it was the vaccine because she was fine even with dialysis. When she got the vaccine it took hours and her health conditions changed.


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