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

This is VAERS ID 1081836



Case Details

VAERS ID: 1081836 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-09
Onset:2021-02-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6789 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Atrioventricular block complete, Bradycardia, Dyspnoea, Electrocardiogram, Fatigue, Loss of consciousness, Nausea, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: DETENSIEL [BISOPROLOL]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease; Hypertension arterial
Allergies:
Diagnostic Lab Data: Test Date: 20210213; Test Name: bradycardia; Result Unstructured Data: Test Result:37/min; Test Date: 20210213; Test Name: ECG; Result Unstructured Data: Test Result:AVB (atrioventricular block) 2 or even 3
CDC Split Type: FRPFIZER INC2021232918

Write-up: Sudden death; suddenly loses consciousness; Atrioventricular block, complete; bradycardia at 37/min; Fatigue; Nausea; Respiration labored; This is a spontaneous report from a contactable physician from the regulatory authority-WEB FR-AFSSAPS-RS20210251. An 88-year-old male patient received the first dose of bnt162b2 (COMIRNATY) lot number: EJ6789, intramuscular on 09Feb2021 at a single dose for covid-19 immunisation. Medical history included hypertension arterial and Alzheimer''s disease. Concomitant medication included bisoprolol (DETENSIEL [BISOPROLOL]) for hypertension. Since 12Feb2021, the patient experienced unusual fatigue (need to stop twice on a 1 km walk outdoors), nausea, episode of labored respiration, without syncope, without discomfort. The patient had a medical consultation on 13Feb2021. Poor clinical examination apart from bradycardia at 37 / min, AVB (atrioventricular block) 2 or even 3 on ECG. No cardiac decompensation. Immediate hospitalization was done. The patient had to be fitted (with a device) on 15Feb2021 for this AVB and on 14Feb2021, the patient has his wife on the phone and shows no complaints or disturbances but fifteen minutes later, he suddenly loses consciousness and dies. The patient died on 14Feb2021. It was not reported if an autopsy was performed. The outcome of other events was unknown at the time of death. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden death


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