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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1155829



Case Details

VAERS ID: 1155829 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Regular Humulin insulin, NPH insulin, Naprosyn, Creon, omeprazole, Allerchlor, Montelukast, metformin, lovastatin, glipizide, losartan
Current Illness: CAD, obesity, Diabetes, cellulitis
Preexisting Conditions: Diabetes, CAD
Allergies: NKA
Diagnostic Lab Data: FSBS 415
CDC Split Type:

Write-up: Cardiopulmonary arrest and death at 0822 4/1/21


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