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

This is VAERS ID 1165283

Case Details

VAERS ID: 1165283 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Agitation; ALS (still goes without treatment.); Continuous positive airway pressure; Dysphasia; Hyperlipidemia; Hypertension; Mood disorder; Sleep apnea (with Continuous positive airway pressure (CPAP) at night.); Smoker; Type 2 diabetes mellitus
Diagnostic Lab Data:
CDC Split Type: FIPFIZER INC2021342468

Write-up: Death/Vomiting; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB FI-FIMEA-20211451. A 63-years-old male patient received second dose of bnt162b2 (COMIRNATY, solution for injection, Lot Number: EJ6134, expiry date not reported), intramuscular on 09Feb2021 at a single dose for covid-19 immunisation. Medical history was reported as follows: In the anamnesis, patient had ALS (amyotrophic lateral sclerosis) diagnosis form Apr2020, and still goes without treatment, dysphasia, sleep apnea with continuous positive airway pressure (CPAP) at night, was a smoker (reported as he smokes), hypertension, hyperlipidemia, type 2 diabetes, agitation and mood disorder. Patient received the first vaccine dose of Comirnaty (lot number: EJ6795) as COVID-19 vaccination on 19Jan2021. Concomitant medications included oral losartan at 50 mg, daily taken for hypertension; oral riluzole (RILUTEK) taken for amyotrophic lateral sclerosis at 50 mg, daily; oral risperidone (RISPERIDON) taken for agitation at 1 mg, daily; oral metformin taken for diabetes mellitus at 500 mg, daily; and oral sertraline taken for mood disorder at 50 mg, daily. Start and stop date were not reported for all concomitant drugs. On 28Feb2021, the patient experienced death/vomiting. Course of event was reported as: Resident staff at the department met patient no later than 28Feb2021 at 00:40, then measured as usual. Looking at patient about 02:45, then he lied lifeless on the floor next to the bed, stiffness of death, is on the right side, and has vomited. Patient had no recent change in the month; no recent trauma. The patient died on 28Feb2021. The cause of death was death/vomiting (as reported). At autopsy, patient had no visible signs of trauma and was referred to forensic autopsy. Given the connection in time between vaccination with Comirnaty and the subsequent sudden death, the death is hereby reported as a suspected / possible vaccine side effect. The result of the forensic autopsy is currently not available to the reporter. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: death/vomiting

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