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From the 2/26/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1041839

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Case Details

VAERS ID: 1041839 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-02-14
Onset:2021-02-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonix 40 mg PO QD Vit D3 50,000 Units PO weekly MVI 1 tab PO QD Calcium Carbonate 600 mg1 PO QD Lantus 28 Units SQ in morning, 24 Units at dinner Iron 65 mg PO QD Monurol 3 gm PO, 3 pkts weekly Colesevelam 3.75 gm oral 1 pkt BID Plavix 7
Current Illness: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Preexisting Conditions: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Allergies: Sulfur
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Death- ~ 7 hours after vaccine


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210226&IDNUMBER=1041839


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