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From the 3/11/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 1092651



Case Details

VAERS ID: 1092651 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-26
Onset:2021-02-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0124214 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: HTN, DM, Cholesterol and blood thinners
Current Illness: +Covid in January 2021
Preexisting Conditions: Cardiac
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210311&IDNUMBER=1092651

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