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From the 4/30/2021 release of VAERS data:

This is VAERS ID 986672

Case Details

VAERS ID: 986672 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Arizona  
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cough, Death, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-28
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 125 MG/5ML Suspension 5 ml in AM and 10 ml in PM Orally thru feeding tube Seroquel 50 MG Tablet 1 tablet Orally Once a day (crush and mix with water and thru feeding tube) Naproxen 125 MG/5ML Suspension 10 ml with food or milk Orally
Current Illness: none
Preexisting Conditions: CVA, seizures, Lung nodule
Allergies: iodine topical betadine
Diagnostic Lab Data: Covid-19 nasal swab
CDC Split Type:

Write-up: Patient tested Covid positive, cough, low oxygen levels, COVID Pneumonia, patient is now deceased

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