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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1574423

Case Details

VAERS ID: 1574423 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Missouri  
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 3
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: Unknown
Preexisting Conditions: COPD, cardiovascular disease
Allergies: Unknown
Diagnostic Lab Data: COVID-19 PCR test positive on 7/26/2021
CDC Split Type:

Write-up: Client tested positive for COVID-19 via PCR on 7/26/2021 after being fully vaccinated. Pfizer vaccine dose #1 administered on 1/22/2021 lot#EL9262 and Pfizer vaccine dose #2 administered on 2/12/2021 lot# EN9581. Client died on 7/29/2021 cause of death as COVID-19 per Coroner''s office.

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