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

This is VAERS ID 1577863



Case Details

VAERS ID: 1577863 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-08-07
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Exposure to SARS-CoV-2, Fall, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 7
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: Chronic heart failure, COPD, hypertension, hyperlipidemia, Coronary artery disease, hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/7/21 Came to ED with shortness of breath and fall from standing. Was exposed to COVID on 7/31/21 and started having symptoms on 8/2/21. Had been vaccinated but test was positive for COVID on admission. On and off ventilator. Started on dexamethasone and remdesivir on 8/9. Oxygen requirements continued to increase. Patient/family elected for comfort measures only and patient died on 8/14/2021.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1577863

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