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

This is VAERS ID 1662602

Case Details

VAERS ID: 1662602 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Ohio  
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Feeling cold, Intensive care, SARS-CoV-2 test positive, Sepsis
SMQs:, Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, ASA, atorvastatin, clopidogel, ferrous sulfate, folic acid, isosorbide mononitrate, levothyroxine, lisinopril, mag ox, metoprolol, NTG, pantoprazole, KCl, prednisone, spironolactone, torsemide, tramadol, trazadone
Current Illness:
Preexisting Conditions: BPH, angina, CAD, CABG, CRT-D, osteoarthritis, CHF, GERD, Depression, Pacemaker, CKD, pacemaker, hyperlipidemia
Allergies: Rofecoxib, ciprofloxacin, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive for COVID 8/8/21 ED on 8/9 feeling could not get warm, dx sepsis most likely d/t COVID -19 moved to ICU pt expired 8/12/21

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