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From the 5/14/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1002057

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Case Details

VAERS ID: 1002057 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: Percocet 5/325 mg, Vitamin B12, Ventolin HFA, Amiodarone, Apixaban, Atorvastatin, Carvedilol, Iron sulfate, Lasix, Gabapentin, Insulin Glargine, Insulin Lispro, Levothyroxine, Lidocaine patch, Protonix, Sertraline,
Current Illness: 1) Deconditioning 2) Osteoporosis with acute T4 compression fracture from coughing in 12/15/20 3) Chest wall pain 4) Anemia due to GI bleed 5) HTN 6) DM 2 7) HFrEF 8) Hyperlipidemia 9) Paroxysmal atrial fibrillation 10) PVD 11) CAD 12) Aortic stenosis 13) Hypothyroidism 14) Anxiety disorder
Preexisting Conditions: See above
Allergies: Baclofen, Sulfa antibiotic
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sudden death

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