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

This is VAERS ID 1161350



Case Details

VAERS ID: 1161350 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-09
Onset:2021-03-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Chest pain, Dyspnoea, Loss of consciousness, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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 (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dyslipidaemia; Hypertension arterial
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021333471

Write-up: Cardiopulmonary arrest/cardiorespiratory arrest; Feeling sick/malaise; Loss of consciousness/consciousness disorder; Dyspnoea; Chest pain; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority. The regulatory authority report number is FR-AFSSAPS-AN20210936. An 81-year-old male patient received the first dose of BNT162B2 (COMIRNATY, lot number and expiry date unknown), intramuscular, on 09Mar2021, at a single dose, for covid-19 immunization. Medical history included dyslipidaemia and hypertension arterial. The patient''s concomitant medications were not reported. The patient was at risk of developing a severe form of Covid-19 disease. It was unknown if the patient previously had Covid-19. It was also unknown if the patient had a Covid-19 PCR or serology test. On 11Mar2021 17:30 the patient experienced feeling sick/malaise with loss of consciousness/consciousness disorder associated with dyspnoea and chest pain. At 17:55 the same day, the patient had a cardiopulmonary arrest/cardiorespiratory arrest (cause of death) and the patient received resuscitative care by the Emergency team of the Emergency Service. The adverse events resulted in the rapid death of the patient. Conclusion reported as: The patient presented a malaise with consciousness disorder and thoracic pain then died rapidly 2 days after a first dose of Comirnaty vaccine. Summary reported as: Man, who has malaise with consciousness disorder, thoracic pain then death 2 days after first administration of Comirnaty. The patient died on 11Mar2021. No autopsy was performed. Nota Bene: Imputation made without prejudice to the elements of investigation which could be carried out within the framework of legal or amicable compensation procedures. Official bulletin of the Department, published in Specific Abstract. No follow-up attempts are possible, information on the lot/batch number cannot be obtained.; Reported Cause(s) of Death: Cardiopulmonary arrest


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