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

This is VAERS ID 1591433



Case Details

VAERS ID: 1591433 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-27
Onset:2021-07-03
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Malaise, Pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VIT C ASPIRIN PLAVIX WELCHOL ZETIA LOPRESSOR
Current Illness:
Preexisting Conditions: CHF
Allergies: MORPHINE
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: COUGH, RUNNY NOSE, FOR TWO WEEKS, GENERAL MALSIE, BODY ACHE


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1591433

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