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From the 1/15/2021 release of VAERS data:

This is VAERS ID 379570

Case Details

VAERS ID: 379570 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:48
Submitted: 2010-02-04
   Days after onset:151
Entered: 2010-02-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Drowning, Fall
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1001USA03763

Write-up: Information has been received from from a physician concerning a 12 year old school going girl of class eight of a village. On 20-JUL-2009, the patient received first dose of GARDASIL in the school. During the process of community mobilization for second dose of GARDASIL, the female health worker was informed that on 06-SEP-2009, the patient accidentally fell in open well (granite quarry filled with water), drowned and expired. This event occurred 49 days of receiving first dose of GARDASIL. The female health worker informed the Medical Officer in-charge, which was then communicated to District Immunization Officer. The medical officer in-charge investigated the death and completed first information report and determined that death was not related to the vaccine.

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