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

This is VAERS ID 1272225

Case Details

VAERS ID: 1272225 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Computerised tomogram head normal, Confusional state, Culture positive, Death, Gait inability, Hypersomnia, Magnetic resonance imaging head abnormal, Neurological symptom, Pneumonia, Respiratory tract congestion, Urinary incontinence, Urinary tract infection, Withdrawal of life support
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Chemotherapy drugs
Current Illness: Smoldering Myeloma (precursor to blood cancer)
Preexisting Conditions: Diabetes controlled through diet.
Allergies: None
Diagnostic Lab Data: Pnuemonua culture, MRi. Displayed stroke symptoms.but CT scan showed no stroke.
CDC Split Type:

Write-up: Confusion 6 days after shot. Within a week lost ability to walk, became urinary incontinent. Major chest congestion, slept all the time. Rushed by ambulance at day 12.. Diagnosed with pneumonia amd uti. Cardiac arrest at day 14, never woke up. Taken off life support 3/20/21.

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