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From the 5/7/2021 release of VAERS data:

This is VAERS ID 884618



Case Details

VAERS ID: 884618 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Nevada  
Vaccinated:2020-08-31
Onset:2020-09-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2020-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION QFAA2006 / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS MT7C9 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-09-03
   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: oxycodone 15 mg, morphine sulfate ER 15 mg, carisoprodol 350 mg, levothyroxine 100 mcg, alprazolam 1 mg
Current Illness: unknown
Preexisting Conditions: hypothyroidism, postlaminectomy syndrome, cervical disc displacement, anxiety
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on September 3, 2020, three days after receiving her vaccines. Her husband believes her death was related to the vaccines and states she was having "all the side effects" but he would not inform us what those side effects included.


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=884618


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