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

This is VAERS ID 1371420

Case Details

VAERS ID: 1371420 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Arizona  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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: unknown
Current Illness: unknown
Preexisting Conditions: gastroesophageal reflux disease degenerative joint disease hepatitis C scoliosis ulnar neuropathy reactive airway disease seasonal allergies chronic pain alcohol abuse hypertension
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient expired 3 days after first vaccination. Did not present to our facility for care after vaccination; did not have any adverse reactions during vaccination waiting period. Per the Medical examiner, patient passed away at his residence, and his death was not related to the COVID vaccine.

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