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

This is VAERS ID 1035841

Case Details

VAERS ID: 1035841 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Illinois  
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
   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: Home Medications Current 2/3/2021: Albuterol-Ipratropium as needed; Allopurinol daily; Aspirin 81mg daily; B complex plus vitamin C daily; Budesonide as needed; Calcitriol 4 times per week; Diphenoxylate-Atropine as needed for diarrhea; Eut
Current Illness: Diarrhea with Cdiff etiology, seen in the Wound Center on 2/3/2021 for a pressure ulcer; Seen in ER on 1/14 with diarrhea, fatigue, cough and shortness of breath labs revealed BUN 20; Cr 1.68; GFR 29; Alk Phos 152.
Preexisting Conditions: AAA with stent; COPD; Dyslipidemia; Hypertension; Kidney Disease; Murmur; Osteoarthritis; Home oxygen use; Stroke; Parkinson''s; Former Smoker; Lung Cancer.
Allergies: Gluten; NSAIDS; Penicillin; Sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death on 2/8/2021 unknown signs and symptoms at time of death; multiple co-morbidities

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