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

This is VAERS ID 1045029



Case Details

VAERS ID: 1045029 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-01-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6788 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Chronic obstructive pulmonary disease; Chronic renal failure; Constipation (Before vaccination, the patient complained of constipation, but stool in the evening); Hypertension arterial; Insulin-requiring type 2 diabetes mellitus; Prosthesis implantation; Sleep apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021160041

Write-up: Sudden death; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB FR-AFSSAPS-RE20210233. An 87-year-old male patient received first dose of BNT162B2 (COMIRNATY, batch/lot number: EJ6788) intramuscularly in the right arm on 29Jan2021 at single dose for covid-19 immunisation. Medical history included chronic renal failure, chronic obstructive pulmonary disease, insulin-requiring type 2 diabetes mellitus (Insulin-dependent diabetes), atrial fibrillation, sleep apnoea syndrome, hypertension arterial, aortic prosthesis. Before vaccination, the patient complained of constipation, but stool in the evening. The patient''s concomitant medications were not reported. Patient was considered to be at risk of developing a severe form of the disease COVID-19, not having contracted COVID-19 and not being tested. First vaccination with BNT162B2 in the right arm on 29Jan2021. After the vaccination, watched by her daughter during the day, at her home. Nothing to report, no clinical signs. Sudden death of the patient occurred at 14:00 on 30Jan2021, at his home noted by the caregiver. The patient died on 30Jan2021. Cause of death reported as sudden death. It was not reported if an autopsy was performed. Outcome is fatal. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Sudden death


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