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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1044950



Case Details

VAERS ID: 1044950 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-04
Onset:2021-02-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1491 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure, Left ventricular failure
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021160519

Write-up: Decompensation cardiac; Failure heart left; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB DE-PEI-PEI2021002453. A male patient of an unspecified age received bnt162b2 (COMIRNATY) batch no.: EL1491, subcutaneous on 04Feb2021 at single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously took bnt162b2 (COMIRNATY) for covid-19 immunisation on 14Jan2021. On the same day after vaccination (04Feb2021) the patient developed Failure heart left and Decompensation cardiac, lasting for 3 day(s). The patient is dead. The patient died in Feb2021. It was not reported if an autopsy was performed. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Failure heart left; Decompensation cardiac


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