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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1244814

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Case Details

VAERS ID: 1244814 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kansas  
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Cough, Death, Dizziness, Laboratory test, Magnetic resonance imaging normal, Muscular weakness, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ventolin Inhaler, Statin and Breo Inhaler
Current Illness:
Preexisting Conditions: COPD
Allergies: Unsure
Diagnostic Lab Data: MRI showed normal age related changes. She had blood work drawn, I do not know the results of it. She was at the Hospital and had an xray and lab work about 2 to 3 weeks before she passed. I do not know the results of the tests at this time.
CDC Split Type:

Write-up: Dizziness off and on for 2 weeks along with muscle weakness and developed a cough about a week after this injection. My mother passed away.

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