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

This is VAERS ID 1211696



Case Details

VAERS ID: 1211696 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-01
Onset:2021-02-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   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: WARFARIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021382454

Write-up: Death sudden; This is a spontaneous report from a contactable consumer received from a regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202104060902445850. A male patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: Not known), dose 1 via an unspecified route of administration on 01Feb2021 17:00 as single dose for COVID-19 immunization. The patient medical history was not reported. Patient has not had symptoms associated with COVID-19 Patient is not enrolled in clinical trial. Concomitant medication included warfarin (WARFARIN) taken for atrial fibrillation, start and stop date were not reported. The patient experienced death sudden on 02Feb2021 08:00. Additional information included: Received vaccine at 5pm, went to bed early and was found dead at 8am the following morning. Patient has not tested positive for COVID-19 since having the vaccine. The patient underwent lab tests and procedures which included COVID-19 virus test: no - negative covid-19 test on unspecified date. The patient died on 02Feb2021. It was not reported if an autopsy was performed. Information about lot/batch number cannot be obtained. Follow-up attempts are completed. No further information is expected; Reported Cause(s) of Death: Death sudden


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