From the 3/29/2024 release of VAERS data:

This is VAERS ID 1689212

Government Disclaimer on use of this data

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