From the 4/26/2024 release of VAERS data:

This is VAERS ID 924186

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Case Details

VAERS ID:	924186 (history)
Form:	Version 2.0
Age:	91.0
Sex:	Female
Location:	Michigan

Vaccinated:	2020-12-30
Onset:	2021-01-03
Days after vaccination:	4
Submitted:	0000-00-00
Entered:	2021-01-06

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA	025J20A / 1	LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-03
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: aldactone, lasix, aspirin, tylenol, potassium, spiriva
Current Illness: Covid positive previous with no s/s poor appetite Chronic wound right leg
Preexisting Conditions: alzheimers dementia, COPD , DM- type 2
Allergies: Codeine, Penicillin, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident expired 1/3/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=924186