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

This is VAERS ID 1273988

Case Details

VAERS ID: 1273988 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topiramate 50 mg dly Lisinopril 20 mg dly Humolog 150 u via pump dly phentermine 37.5 mg dly glycopryrrolate 1 tab po TID Q8hours
Current Illness:
Preexisting Conditions: diabetes asthma
Allergies: vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had vaccination 4/7/2021 and started having symptoms 04/25/2021 arrived at the ER today with hypoxia

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