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

This is VAERS ID 1124259

Case Details

VAERS ID: 1124259 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Colorado  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: No adverse event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   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: Bupropion, Eliquis, lisinopril, metoprolol tartrate
Current Illness: No acute illnesses noted
Preexisting Conditions: CHF, pulmonary nodules, HYN, hypothydoism, AFib, mitral valve regurgitation, AAA, anxiety, aortic stenosis...Basal cell carcinoma of the right eyelid, cardiac murmur, biatrial enlargement, LBBB, left ventricular hypertrophy, mitral valve insufficiency, nonsustained ventricular tachycardia, premature ventricular contraction, retinal detachment of right eye
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reactions reported by family

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