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

This is VAERS ID 1211031



Case Details

VAERS ID: 1211031 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-10
Onset:2021-03-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP2166 / 1 - / 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: 2021-03-24
   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: ATORVASTATIN; BISOPROLOL; CLOPIDOGREL; KAYEXALATE; LEVOTHYROXINE; OROCAL [CALCIUM CARBONATE]; PANTOPRAZOLE; PARACETAMOL; RENVELA; SPECIAFOLDINE; TRINITRIN; UN ALFA; WARFARIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic hemodialysis; Chronic kidney disease stage 5 (with hemodialysis); Coronary bypass (triple coronary bypass grafting); Ischaemic heart disease ((triple coronary bypass grafting with complications)); Peripheral arterial occlusive disease (multi-stented PAD); Valvular heart disease NOS ((calcified aortic stenosis tight))
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021380261

Write-up: sudden death; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-NT20210907. A 65-year-old male patient received first dose of bnt162b2 (COMIRNATY, solution for injection, lot: EP2166), intramuscular on 10Mar2021 as single dose for covid-19 immunisation. Medical history included chronic kidney disease stage V (with hemodialysis), chronic hemodialysis, peripheral arterial occlusive disease (multi-stented PAD), ischaemic heart disease (triple coronary bypass grafting with complications) and valvular heart disease (calcified aortic stenosis tight). Concomitant medications included atorvastatin; bisoprolol; clopidogrel; sodium polystyrene sulfonate (KAYEXALATE); levothyroxine; calcium carbonate (OROCAL); pantoprazole; paracetamol; sevelamer carbonate (RENVELA); folic acid (SPECIAFOLDINE); glyceryl trinitrate (TRINITRIN); alfacalcidol (UN ALFA) and warfarin. The patient did not have Sars-CoV2 infection. The physician reported sudden death of the patient in a few minutes while preparing to come to his dialysis session on 24Mar2021. He was 14 days after a first dose of bnt162b2 and had a significant cardiovascular history. The patient died on 24Mar2021. It was unknown if 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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