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

This is VAERS ID 1632537

Case Details

VAERS ID: 1632537 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Georgia  
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Disorientation, Dyspnoea, Fatigue, Feeling abnormal, General physical health deterioration, Nasopharyngitis, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Sick relative, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 5
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:
Current Illness:
Preexisting Conditions: Cardiovascular disease, hypertension, obesity
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19. Patient was fully vaccinated. He started feeling "different" about the middle of July. He was more fatigued, disoriented, and unstable. The following week, he developed cold symptoms which everyone assumed was just the common cold. Pt. daughter was sick the previous week with a common cold (took her 3yo to the doctor to confirm, but wasn''t tested for Covid). After 7/26, his condition started to deteriorate more with fever and vomiting. By the evening of 07/30, he was having great difficulty breathing and so he was taken to the hospital. He was admitted for very low blood oxygen levels as well as Covid pneumonia. He has several underlying health conditions to include heart disease and obesity. Patient died due to COVID.

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