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

This is VAERS ID 1225069



Case Details

VAERS ID: 1225069 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-14
Onset:2021-03-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Auricular fibrillation; Gout; Hypothyroidism; Infarct myocardial
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021398740

Write-up: Tachycardia, death; This is a spontaneous report from a contactable Consumer downloaded from a regulatory authority-WEB FR-AFSSAPS-BR20211119 and received via a pharmaceutical company. A 85-years-old female patient received first dose of bnt162b2 (COMIRNATY, Batch/Lot Number: Unknown), intramuscular on 14Mar2021 as single dose for COVID-19 immunization. Medical history included Gout, Hypothyroidism, Auricular fibrillation from Aug2017, Infarct myocardial from Jan2017. The patient''s concomitant medications were not reported. The patient experienced tachycardia, death (fatal tachycardia) on 17Mar2021. The patient died on 17Mar2021. An autopsy was not performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. ; Reported Cause(s) of Death: Tachycardia, death


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