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

This is VAERS ID 1178071



Case Details

VAERS ID: 1178071 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-24
Onset:2021-02-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 RA / IM

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

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: Lantus, Humalog, omeprazole, furosemide, loratadine, metoprolol, ASA 325mg, atorvastatin, benzonatate, metolazone, Hydrochlorothiazide, hydralazine, montelukast
Current Illness: None
Preexisting Conditions: Diabetes Mellitus, Chronic renal failure on dialysis, peripheral vascular disease, CAD with multiple stents, CIDP, CHF
Allergies: Bee venom protein
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient found expired at home about 12 hours after administration of vaccine


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