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

This is VAERS ID 1161733



Case Details

VAERS ID: 1161733 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4240 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Malaise, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Congestive heart failure (Background : CHF and additional diseases)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ILPFIZER INC2021330350

Write-up: Difficulty breathing difficulty including an event of choking and loss of consciousness. Emergency Service invited to the scene determined his death; Peripheral edema began to appear in limbs which worsened.; A day after the second dose started to feel bad, general bad feeling.; This is a spontaneous report from a contactable other HCP received from Regulatory Authority (Attached is a file of reports of hospitalizations and deaths in the vicinity of receiving a vaccine against Corona, updated to 25Mar2021. The reports were received in the epidemiology department division by medical staff. Please note that the file has 2 tabs: hospitalizations, deaths.Patient number.) A male patient of an unspecified age (89, units unknown) received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Lot Number: EK4240), second dose via an unspecified route of administration on an unspecified date, single dose for covid-19 immunisation. Medical history included Congestive Heart Failure from an unknown date, Background : CHF and additional diseases. The patient''s concomitant medications were not reported. Difficulty breathing difficulty including an event of choking and loss of consciousness. Emergency Services invited to the scene determined his death. A day after the second dose, patient started to feel bad, general bad feeling. Peripheral edema began to appear in limbs which worsened. The patient refused to hospitalization or receiving medical treatment. The events were assessed as serious, fatal outcomes, cause of deaths. Patient died on an unspecified date. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Difficulty breathing difficulty including an event of choking and loss of consciousness; Peripheral edema began to appear in limbs which worsened.; A day after the second dose started to feel bad, general bad feeling.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1161733

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