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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1003329

Case Details

VAERS ID: 1003329 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Death, Malaise, Unresponsive to stimuli, Vaccination site pain, Vaccination site swelling
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   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: Per medical record: alendronate, amlodipine, aspirin, atorvastatin, benazepril, calcium-Vitamin D, diclofenac, ezetimibe, glimeperide, hydrochlorothiazide, latanoprost opthalmic, topical lidocaine, metformin, Artificial Tears, Lacri-Lube, p
Current Illness: No known recent illnesses per medical record
Preexisting Conditions: Per medical record: type 2 diabetes, hypercholesterolemia, hypertension, non-proliferative diabetic retinopathy, borderline glaucoma, osteoarthritis, obesity
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient''s primary care provider received a death certificate to be signed for this patient. He spoke with the patient''s husband and son, who reported that the patient had pain and swelling at the vaccine administration site after receiving the vaccine and was feeling unwell after receiving the vaccine. The patient''s family reported that they found her unresponsive on 2/2/21 and called 9-1-1. The patient was pronounced dead upon arrival of emergency responders.

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