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

This is VAERS ID 1689212



Case Details

VAERS ID: 1689212 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-17
Onset:2021-07-20
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       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: 2021-08-29
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 51 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CETIRIZINE, ERGOCALCIFEROL,
Current Illness: STAGE IV TESTICULAR EMBRYONAL RHABDOMYOSARCOMA W/ LUNG & BONE METASTASES
Preexisting Conditions: SEE ABOVE
Allergies: VANCOMYCIN, TEMSIROLIMUS
Diagnostic Lab Data:
CDC Split Type:

Write-up: SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1689212

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