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

This is VAERS ID 1273511

Case Details

VAERS ID: 1273511 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Tennessee  
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Atrial fibrillation, Chest X-ray abnormal, Death, Lung consolidation, Nausea, Septic shock, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Toxic-septic shock conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   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: Warfarin, Alendronate, Omeprazole, Rosuvastatin, Losartan, Metoprolol, Hydrochlorithiazide
Current Illness: None
Preexisting Conditions: DM II, CKD, Osteoporosis, Hypertensive heart and kidney diease, Hyperlipid, B12 deficiency, History of DVT
Allergies: Side effects to Actonel and Atorvastatin
Diagnostic Lab Data: CXR- mild bilateral bibasilar airspace disease
CDC Split Type:

Write-up: Patient recieved Moderna dose 1 02/23/2021, dose 2 03/25/2021. Nausea and vomitting after 2nd dose, found unresponsive by son on 04/17/2021, taken to ER and diagnosed with new onset Afib with RVR, sepsis with shock. Deceased 04/18/2021

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