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

This is VAERS ID 1165307



Case Details

VAERS ID: 1165307 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-03
Onset:2021-03-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2659 / 2 LA / 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: 2021-03-15
   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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021342466

Write-up: Sudden death; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority number is FR-AFSSAPS-TO20211924. An 84-year-old male patient received the second dose of BNT162B2 (COMIRNATY Solution for injection, lot number: ER2659, expiry date: unknown), intramuscular in the left arm, on 03Mar2021, as single dose, for covid-19 immunisation. There were no medical history and concomitant medications. Historical vaccine included the first dose of BNT162B2 (COMIRNATY Solution for injection, lot number: EM 0477, expiry date: unknown), intramuscular in the left arm, on 05Feb2021, for COVID 19 immunisation. The patient experienced sudden death on 15Mar2021. Discovery of the body at home and declaration of death was on 15Mar2021. The patient was in excellent general condition, was a marathon runner, was an active athlete despite his age, was totally independent and lived alone. It was unknown if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden death


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