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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 996959

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Case Details

VAERS ID: 996959 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-01
Onset:2021-02-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: Lasix, Morphine, Ernesto, Oxycodone, omeprazole Gabapentin
Current Illness: CHF. COPD Chronic Pain
Preexisting Conditions: CHF, COPD, Polio as a child
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Vaccine was administered Thursday and my father Died early Monday morning unexpectedly


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=996959


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