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From the 10/15/2021 release of VAERS data:

This is VAERS ID 994778



Case Details

VAERS ID: 994778 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-01-22
Onset:2021-01-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Death, Decreased appetite, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pepcid, Aspirin, DOK Plus, Miralax, Potassium Chloride ER, Vitamin C, Ensure Clear, Metoprolol Tartrate, Tramadol, Artificial Tears,
Current Illness:
Preexisting Conditions: OTHER INTERVERTEBRAL DISC DEGENERATION, LUMBAR REGION, Macular Degeneration, Anorexia, Peripheral Vascular Disease, Cardiac Arrhythmia,
Allergies: No known allergies
Diagnostic Lab Data: COVID-19 PCR test positive on 1-28-21
CDC Split Type:

Write-up: Resident received the vaccine on 1-22-21 and she was diagnosed with COVID-19 during routine testing on 1-28-21. She didn''t have any symptoms except feeling weak and she had a decrease in her appetite. She already had a poor appetite prior. She died on 2-2-21.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=994778

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