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

This is VAERS ID 1045006



Case Details

VAERS ID: 1045006 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-14
Onset:2021-01-27
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6795 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Seizure, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   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: TRIOBE [CYANOCOBALAMIN;FOLIC ACID;PYRIDOXINE HYDROCHLORIDE]; PANADOL FORTE [PARACETAMOL]; MELATONIN ORION; VENLAFAXIN KRKA; MEMANTIN ORION; AMLODIPIN ORION [AMLODIPINE BESILATE]; OPAMOX; OXYNORM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease; Depression; Gout; Hyperplasia of the prostate; Hypertension; Insomnia; Pain; Restlessness
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIPFIZER INC2021159025

Write-up: Sudden death; sudden seizure; a sudden stroke of a brain or heart origin; This is a spontaneous report from a non-contactable physician downloaded from the Medicines Agency (MA) Regulatory authority-WEB FI-FIMEA-20210540. A 77-year-old male patient received his first dose of bnt162b2 (COMIRNATY, lot number EJ6795), intramuscular on 14Jan2021 at single dose for COVID-19 vaccination. Medical history included Alzheimer''s disease, hypertension, prostate hyperplasia, gout, depression, pain, insomnia and restlessness. Concomitant medication included cyanocobalamin, folic acid, pyridoxine hydrochloride (TRIOBE), paracetamol (PANADOL FORTE) for pain, melatonin (MELATONIN ORION) for insomnia, venlafaxine hydrochloride (VENLAFAXIN KRKA) for depression, memantine hydrochloride (MEMANTIN ORION) for Alzheimer''s disease, amlodipine besilate (AMLODIPIN ORION) for hypertension, oxazepam (OPAMOX) for restlessness and oxycodone hydrochloride (OXYNORM). The patient experienced sudden death on 27Jan2021. The patient died of a sudden seizure 13 days after the vaccination on 27Jan2021. There were no specific symptoms during or after administration of the vaccine and well-being was normal between administration and death. Sudden seizure appeared on the night of January 27, 2021, the patient was found in a semi-sitting position, gasping breathing, pale face, and no speech contact could be made with him. Shortly thereafter, he became lifeless. Resuscitation was not performed according to treatment guidelines. Underlying diseases: Alzheimer''s disease, hypertension, prostate hyperplasia, gout, depression. First dose of vaccine. Based on preliminary data and event data, reporter thought it wa unlikely that the administration of the vaccine would have resulted in death. Death compatible rather with a sudden stroke of a brain or heart origin, to which the underlying diseases were predisposing. The patient died on 27Jan2021. It was unknown if an autopsy was performed. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: sudden death; sudden seizure; a sudden stroke of a brain or heart origin


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