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From the 5/14/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1068743

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Case Details

VAERS ID: 1068743 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-02-09
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: 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: 2021-02-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bamlanivimab; Aspirin; Lumigan; Citracal + D3; Chondroitin sulfate a; gabapentin; ipratropium; levothyroxine; losartan; metoprolol; multivitamin; nitroglycerin; fish oil; ranolazine; viagra; simvastatin; maxzide
Current Illness:
Preexisting Conditions: allergic to iodine and naproxen. past medical history including hypertension, type 2 diabetes, bladder cancer, hypothyroidism, coronary artery disease, 2 heart attacks, prostrate cancer, and vitamin d deficiency.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bamlanivimab treatment under Emergency Use Authorization(EUA): Bamlanivimab treatment under Emergency Use Authorization(EUA). Patient received 1st dose of COVID vaccine on 01/28/2021, but he began to have COVID symptoms on 02/04/2021 and tested positive on 02/05/2021. The patient was treated with banlanivimab on 02/08/2021, and he passed away on 02/09/2021.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1068743


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