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From the 4/30/2021 release of VAERS data:

This is VAERS ID 893549



Case Details

VAERS ID: 893549 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2020-10-21
Onset:2020-10-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2020-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS XJ3ZT / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Endotracheal intubation, Loss of consciousness, Malaise, Resuscitation, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, omeprazole, hydrocodone-acetaminophen, duloxetine, trazodone, cyclobenzaprine
Current Illness: oral lesion/growth that was scheduled for biopsy on 10/29/20
Preexisting Conditions: chronic migraine, interstitial cystitis, gerd, recurrent depression, anxiety
Allergies: none
Diagnostic Lab Data: As reported by daughter: no MI, no brain aneurysm, no PE, no intoxication
CDC Split Type:

Write-up: Sudden death on 10/25/20, 9:15AM. Patient''s adult daughter reports patient awoke on 10/25/20 AM feeling unwell and eventually lost consciousness. Had to be resuscitated and eventually intubated.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=893549


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