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

This is VAERS ID 981406

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Case Details

VAERS ID: 981406 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-15
Onset:2021-01-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebrovascular accident, Death
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multiple, unknown
Current Illness:
Preexisting Conditions: COPD, smoker
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stroke, death


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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=981406


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