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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1075363



Case Details

VAERS ID: 1075363 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-25
Onset:2021-02-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TBD
Current Illness: NA
Preexisting Conditions: DM Type II
Allergies: TBD
Diagnostic Lab Data: Coroner report/autopsy
CDC Split Type:

Write-up: Death due to Moderna 2nd dose, pulmonary thromboembolism


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1075363

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