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

This is VAERS ID 1202873



Case Details

VAERS ID: 1202873 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-22
Onset:2021-03-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN1198 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Asthenia, Body temperature, Cardio-respiratory arrest, Chills, Erythema, Fatigue, Headache, Irritability, Nausea, Pain, Pyrexia, Sensitive skin, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   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: Arterial hypertension (from 7 or 8 years of evolution); Cardiac disorder; Edema lower limb; Hyperuricemia (in treatment)
Allergies:
Diagnostic Lab Data: Test Date: 20210323; Test Name: Body temperature; Result Unstructured Data: Test Result:upper or equal than 38 Centigrade; Comments: Fever
CDC Split Type: MXPFIZER INC2021386393

Write-up: it was an acute infarction of the myocardium; irreversible cardiorespiratory arrest to resuscitation maneuvers; Fever upper or equal than 38 centigrade; Headache; Asthenia/Fatigue, Adynamia; Asthenia/Fatigue, Adynamia; Irritability; Chills; Pain; Sensitivity; Erythema/Redness; Nausea; Vomiting; This is a Spontaneous report from a non-contactable other health professional. This is a report received from the regulatory authority via email. Regulatory authority report number is 12650-4. An 83-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) dose 1 intramuscular, administered in left arm on 22Mar2021 (Lot Number: EN1198; Expiration Date: 01Jun2021) as single dose for covid-19 immunization (age at vaccination: 83 years old). Medical history included cardiopathy and arterial hypertension from 7 or 8 years of evolution, hyperuricemia in treatment, and lower limbs edema, all from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient previously took telmisartan, hydrochlorothiazide, atorvastatin +pharma, alopurinol. On 23Mar2021, the patient experienced fever upper or equal than 38 centigrade, headache, asthenia/fatigue, adynamia, irritability, chills, pain/sensitivity, erythema/redness, nausea, vomiting, dyspnea/respiratory distress, intense precordial pain, dyspnea and anguish. Clinical course was reported as follows. The covid-19 vaccine was applied, on 22Mar2021, the next day he started with intense precordial pain at 02:00 am, with minimum effort dyspnea, anguish and anxiety. They called a particular physician, who already found him in irreversible cardiorespiratory arrest to resuscitation maneuvers, so the physician refers that it was an acute infarction of the myocardium. Timeframe between vaccination and starting of symptoms: 11 hours. The events acute infarction of the myocardium and irreversible cardiorespiratory arrest to resuscitation maneuvers were fatal; while outcome of the rest of the events was unknown. The patient died on 23Mar2021. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: acute infarction of the myocardium


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