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

This is VAERS ID 1088216

Case Details

VAERS ID: 1088216 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   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: Unknown
Current Illness: Unknown prior to first dose; in between first and second dose Hospitalization for UTI with septic shock, hypothermia; metabolic encephalopathy; severe metabolic acidosis
Preexisting Conditions: Anemia; apnea; arthritis; back pain; bladder problem; CHF; Depression; Diabetes; Difficulty swallowing food; dyslipidemia; falls; fistula; gout; headaches; hypertension; low back pain with neurostimulator in spine; Nonsustained v. tach 2019; obesity; peptic ulcer; pneumonia 2019; spinal stenosis; CKD stage III.
Allergies: Adhesive bandage; adhesive tape; cephalexin; cipro; latex; motrin; NSAIDS; Paxil; Sulfa; Zosyn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 30 days of vaccination

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