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

This is VAERS ID 1202954



Case Details

VAERS ID: 1202954 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-17
Onset:2021-03-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3620 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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: Acute myocardial infarction (condition after acute myocardial infarction); Atherosclerosis generalized; Type II diabetes mellitus (with vascular complications)
Allergies:
Diagnostic Lab Data:
CDC Split Type: SIPFIZER INC2021379710

Write-up: Sudden cardiac death; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB, regulatory authority number SI-JAZMP-NCPHV-2021SI0371_0371. A 78-year-old male patient received the second dose of BNT162B2 (COMIRNATY; lot number: ET3620, expiry date: 30Jun2021), intramuscular on 17Mar2021 at single dose for COVID-19 immunisation. The patient''s medical history included type II diabetes mellitus with vascular complications, atherosclerosis generalized, acute myocardial infarction (condition after acute myocardial infarction). The patient''s concomitant medications were not reported. The patient previously received the first dose of BNT162B2 (COMIRNATY) on an unspecified date for COVID-19 immunization. On 25Mar2021, the patient experienced sudden cardiac death. The outcome of the event was fatal. It was not reported if an autopsy was performed. This case report was assessed as medically significant. No additional data arrived in the initial case report. Sender Comment: Further data on the case along with the assessment is expected. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden cardiac death


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