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

This is VAERS ID 1044993



Case Details

VAERS ID: 1044993 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-28
Onset:2021-01-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0477 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   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: OMEPRAZOLE; ZOPICLONE; FEROPLEX; TRAZODONE; DISTRANEURINE [CLOMETHIAZOLE]; CLOPIDOGREL; LEVETIRACETAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic kidney disease; Chronic liver disease; Cognitive impairment; Dyslipidemia; Epilepsy; Hypertension; Living in nursing home
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC2021158467

Write-up: Heart arrest; This is a spontaneous report from a contactable other Healthcare Professional downloaded from the Regulatory Authority-WEB, Regulatory Authority number ES-AEMPS-738908. A 93-year-old male patient received the second dose of bnt162b2 (COMIRNATY), batch/lot number: EM0477, intramuscularly on 28Jan2021 at 0.3 mL, single for covid-19 immunization. Medical history included Chronic kidney disease, Chronic liver disease, Living in nursing home, cognitive impairment, epilepsy, hypertension, and dyslipidaemia. Concomitant medications included omeprazole 20 mg/12H, zopiclone 7.5 mg / night, iron succinyl-protein complex (FEROPLEX) 800mg / day, trazodone 100mg / night, clomethiazole (DISTRANEURINE) 2 / day, clopidogrel 75mg / day, levetiracetam 500mg / 8 hour. The patient previously received the first dose of bnt162b2 intramuscularly on 07Jan2021 at 0.3 mL, single for covid-19 immunisation. The patient experienced heart arrest on 30Jan2021 and died on 30Jan2021. They notify the Emergency Coordinating Center for sudden death. Death was certified. An autopsy was not performed. The outcome of heart arrest was fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: heart arrest


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