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From the 5/7/2021 release of VAERS data (an older release, current is 7/16/2021):

This is VAERS ID 1032327



Case Details

VAERS ID: 1032327 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-04
Onset:2021-02-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: SARS-CoV-2 test negative, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PUREED diet, Pureed texture NX: ICE CREAM (EXTRA DESSERT) two times a day @ LUNCH AND DINNER PROSTAT SUGAR FREE Give 30 cc orally two times a day for SUPPLEMENT WITH MEDPASS TO PROVIDE 30GRAMS PROTEIN AND 200CNX: HEALTHSHAKE 4OZ. PO thre
Current Illness: None
Preexisting Conditions: Heart Failure Chronic Kidney Dse. Dementia Atheroschlerotic Heart Dse. Anemia Hypothyroidism Major Depressive Disorder Nonrheumatic aortic valve stenosis Cardiomegaly Hypertension Dysphagia Osteoporosis
Allergies: Fosamax, Linzess
Diagnostic Lab Data: tested NEGATIVE for COVID-19 on 2/8/2021 Has completed and fully vaccinated last 1/7/2021 and 2/4/2021.
CDC Split Type:

Write-up: On monitoring for weight loss .


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=1032327


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