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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1215280



Case Details

VAERS ID: 1215280 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-25
Onset:2021-04-08
   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 EP9605 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210325; Test Name: Body temperature; Result Unstructured Data: Test Result:36.6 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021398357

Write-up: Ventricular fibrillation; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21101289.?? A 51-year-old (reported as 51-year and 4-month-old) male patient received bnt162b2 (COMIRNATY, Lot Number: EP9605; Expiration Date: 30Jun2021), dose 1 via an unspecified route of administration on 25Mar2021 11:39 as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient''s family history was not reported. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). Body temperature before vaccination was 36.6 degrees Centigrade. On 08Apr2021 at after 0:00, just after midnight (14 days after the vaccination), the patient experienced ventricular fibrillation and was admitted to the hospital. The course of the event was as follows: On 08Apr2021, after 0:00, just after midnight (14 days after the vaccination), the patient was found in respiratory arrest in his sleep. Cardiopulmonary resuscitation (CPR) was initiated, and the patient was transferred to a hospital. CPR was continued, but the patient died. The reporting physician was told by the patient''s family that the cause of death was ventricular fibrillation. The reporting physician noted the details of the clinical course were unknown because it was hearsay. The reporting physician classified the event as serious (death) and assessed that the causality between the event and bnt162b2 as unassessable. Other possible cause(s) of the event such as any other diseases was not reported. The patient underwent lab tests and procedures which included body temperature: 36.6 centigrade on 25Mar2021 before vaccination. The patient died on 08Apr2021. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: Ventricular fibrillation


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