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

This is VAERS ID 1113895



Case Details

VAERS ID: 1113895 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Infarction
SMQs:, Myocardial infarction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ROPFIZER INC2021273221

Write-up: infarction; This is a spontaneous report from a contactable pharmacist. This report was received via a sales representative. A male patient of an unspecified age, young, less than 50 years old, received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) lot number and expiration date not reported, via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced infarction on an unspecified date. The patient was vaccinated at local clinic and on the same day, in the evening, he suffered an infarction and died on unknown date. It is now being investigated whether it was related to the vaccine or not. The patient died on an unspecified date. It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information is expected. The information about lot number and expiration date cannot be obtained.; Sender''s Comments: Based on the limited information available particularly on patient''s past medical history, and plausible temporal association, the causal association between BNT162B2 and the event fatal infarction cannot be completely excluded at the time of review. This assessment will be updated should additional information become available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: infarction


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