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

This is VAERS ID 1153730



Case Details

VAERS ID: 1153730 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4240 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dyspnoea, Myocarditis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes; Hypercholesterolemia; Hypertension; Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: ILPFIZER INC2021330432

Write-up: Brought to the emergency room due to myocarditis; cough; difficulty breathing mainly when lying down; fever for three days; This is a spontaneous report from a contactable other healthcare professional via Agency Regulatory Authority. A 47-year-old male patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot Number: EK4240) as SINGLE DOSE for COVID-19 immunisation. Medical history included Hypertension, hypercholesterolemia, hypothyroidism, diabetes with target organ damage. The patient received first dose of vaccine on unspecified date. The patient''s concomitant medications were not reported. The patient was brought to emergency room due to myocarditis, fever for three days, cough and difficulty breathing mainly when lying down. He was anesthetized and resuscitated due to his rapidly deteriorating condition. The patient died due to myocarditis. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. Batch/lot number already provided.; Sender''s Comments: Linked Report(s) : IL-PFIZER INC-2020517122 same reporter/vaccine, reporting similar events in different patients; Reported Cause(s) of Death: myocarditis


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