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

This is VAERS ID 1275922

Case Details

VAERS ID: 1275922 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Washington  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chills, Cough, Death, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 39
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: Aspirin, atorvastatin, azithromycin
Current Illness:
Preexisting Conditions: CLL on expectant management and CAD
Allergies: None
Diagnostic Lab Data: COVID-19 positive 3/8/21
CDC Split Type:

Write-up: On 3/8/21, patient presented to the ED with cough, fever $g 103, chills, SOB, all starting 9 days ago (2/27/21) about 3 days after 2nd dose of Pfizer vaccine. Patient was admitted to the hospital with main diagnosis COVID-19 pneumonia and patient expired on 4/8/21.

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