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

This is VAERS ID 1151812



Case Details

VAERS ID: 1151812 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-04
Onset:2021-03-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET1831 / 1 - / 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: 2021-03-11
   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: GABAPENTIN; LOSARTAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cholecystectomy; Cholelithiasis (resolved by endoscopic retrograde cholangiopancreatography); Hypertension; Pancreatitis (resolved by endoscopic retrograde cholangiopancreatography)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC2021311680

Write-up: Sudden death; This is a spontaneous report from a contactable other healthcare professional downloaded from the Regulatory Authority-WEB ES-AEMPS-790777. An 89-year-old female patient received the first dose of bnt162b2 (COMIRNATY, lot number: ET1831), intramuscular on 04Mar2021 as a single dose for covid-19 immunisation. Medical history included hypertension, cholelithiasic pancreatitis, resolved by endoscopic retrograde cholangiopancreatography, and cholecystectomy. Concomitant medications included gabapentin taken for an unspecified indication from 02Oct2019; losartan taken for hypertension from 12Sep2012. The patient''s condition when she was vaccinated was stable, without serious pathologies. Then it was reported that the patient had a sudden death on 11Mar2021 (duration of 8 hours as reported). The outcome of the event was fatal. The cause of death was unknown. The patient died on 11Mar2021. It was unknown if an autopsy was performed. Additional information on ADRs: The registered patient was vaccinated on March 4, 2021 with the first dose of the PFIZER covid vaccine. On March 11, her death was reported. The patient''s condition when she was vaccinated was stable, without serious pathologies. 11Mar2021 the daughter comments to me that last night was ok, talked with her and met with her that morning to go to auditory center. "I call the family and at the end the home emergency services have signed the certificate of death of." 11Mar2021 the patient has died, home emergency services at her home did not certify death, because the family has told them that the deceased was phenomenal and they did not know what cause to put. There are no signs of violence. Under these circumstances I am not going to sign the certificate either. No toxic habits. Hypertension. No diabetes mellitus. No dislipemia. Cholelithiasic pancreatitis, resolved by endoscopic retrograde cholangiopancreatography. No other pathological history. Background surgery: Cholecystectomy No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: unknown cause of death


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