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

This is VAERS ID 1054192



Case Details

VAERS ID: 1054192 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-16
Onset:2021-02-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   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: Unk
Current Illness: None listed
Preexisting Conditions: None listed
Allergies: NKA
Diagnostic Lab Data: Unk
CDC Split Type:

Write-up: Pt''s wife reports death 2/23/2021


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1054192

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