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From the 5/14/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 1053978

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Case Details

VAERS ID: 1053978 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-23
Onset:2021-02-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Death, Pain, Pyrexia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   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: Albuterol sulfate inhaler, atenolol, ipatropium-albuterol nebulizer, Sensipar, lisinopril, Incruse Ellipta, lovastatin, pantoprazole, furosemide, trazodone, diclofenac gel, triamcinolone cream, fluticasone nasal spray
Current Illness: none
Preexisting Conditions: CKD Stage 3, COPD, hyperlipidemia, secondary hyperparathyroidism
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt woke up at 0400 with fever, chills, and body aches progressing over 4 hours to the point when she became unresponsive. husband called 911, pt was declared dead at the time of EMS arrival around 1200


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1053978


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