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

This is VAERS ID 1045039



Case Details

VAERS ID: 1045039 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-21
Onset:2021-01-23
   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 - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   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: Disease Parkinson''s; Ischaemic heart disease
Preexisting Conditions: Medical History/Concurrent Conditions: General physical health deterioration (for 1 month); Living in nursing home; Myocardial infarction; Wheelchair user
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021160108

Write-up: Edema pulmonary; flare-up of heart failure; This is a spontaneous report from a contactable consumer from the Medicines Agency (MA) Regulatory authority-WEB regulatory authority number FR-AFSSAPS-TS20210221. A 91-year-old male patient received bnt162b2 (COMIRNATY), intramuscular on 21Jan2021 12:35 at single dose for covid-19 immunisation. Medical history included ongoing Ischaemic heart disease; ongoing Disease Parkinson''s; Living in nursing home (in EHPAD); myocardial infarction from 2009 and unknown if ongoing; Use a wheelchair from an unknown date and unknown if ongoing; Alteration of the general condition for 1 month. The patient''s concomitant medications were not reported. The patient experienced edema pulmonary on 23Jan2021 and died on 23Jan2021.Post-injection monitoring: no arterial hypertension. Monitoring for 48 hours: nothing to report. 23Jan2021 in the morning he did not feel well.Call from the doctor who came to see him in the morning.On arrival, there were clinical signs of the beginning of pulmonary edema. The patient received medical care but death at 4:32 p.m.In all, a fatal flare-up of heart failure on day 2 of vaccination with Comirnaty in a patient with ischemic heart disease who has had a deterioration in his general condition for 1 month. An autopsy was not performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: flare-up of heart failure; Edema pulmonary


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