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From the 11/19/2021 release of VAERS data:

This is VAERS ID 568282

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Case Details

VAERS ID: 568282 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
   Days after vaccination:127
Submitted: 2015-03-05
   Days after onset:1510
Entered: 2015-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Public
Symptoms: Asthenia, Chills, Confusional state, Death, Dyspnoea, Fatigue, Laboratory test, Lymphadenopathy, Malaise, Muscular weakness, Pain in extremity, Rash, Skin infection, Urticaria, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-02-14
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~HPV (Gardasil)~~15.92~Patient
Other Medications: Nothing
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: All tests were complicated
CDC Split Type:

Write-up: Hives, swollen glands, chills, difficult breathing, feeling unwell, rash, skin infection, muscle weakness, tiredness, weakness confusion, leg pain and wheezing.

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