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

This is VAERS ID 928933

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Case Details

VAERS ID:	928933 (history)
Form:	Version 2.0
Age:	56.0
Sex:	Female
Location:	Iowa

Vaccinated:	2020-12-23
Onset:	2021-01-08
Days after vaccination:	16
Submitted:	0000-00-00
Entered:	2021-01-08

Vaccination / Manufacturer	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA	025J202A / 1	RA / IM

Administered by: Unknown Purchased by: ?
Symptoms: Death, Resuscitation
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had been diagnosed with COVID-19 on Dec. 11th, 2020. Symptoms were thought to have started on 12/5/2020. Received Moderna vaccine on 12/23. Unexpected death on 1/8/2021. Resuscitation attempts unsuccessful

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