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From the 5/14/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 1082717



Case Details

VAERS ID: 1082717 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 RA / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   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: N/A
Current Illness: Positive for Covid 1/16/2021 and negative for Covid 1/17/2021
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Autopsy performed 2/20/2021. Reason for death: UNKNOWN.
CDC Split Type:

Write-up: Patient dropped dead 24 hours after receiving the vaccine. The vaccine killed her. She received the vaccine 2/16/2021 and died 2/17/2021


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1082717

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