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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1072763

Case Details

VAERS ID: 1072763 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Puerto Rico  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Dizziness, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: The patient was convalescent from COVID-19, his first positive PCR COVID-19 test was on December 23, 2020. The patient was hospitalize on December 22, 2020 and was check out on December 25, 2020.
Preexisting Conditions: Diabetes and AIDS
Allergies: Unknown
Diagnostic Lab Data: The patient had a PCR test for COVID-19 on February 6, 2021, the result was positive.
CDC Split Type: PR-48-21

Write-up: The same day that the person was vaccinated he started feeling dizzy and had difficulty breathing. He was hospitalized from February 5 to February 23. Patient died in the hospital on February 23, 2021

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