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

This is VAERS ID 1226663



Case Details

VAERS ID: 1226663 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-03
Onset:2021-04-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER9470 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021398757

Write-up: The person was vaccinated at home and found in asystole, the 118 was called and the person died.; This is a spontaneous report from a contactable physician downloaded from the regulatory authority, manufacturer report number IT-MINISAL02-710964. A 55 years male patient received first dose of BNT162B2 (COMIRNATY, formulation: Solution for injection, lot number: ER9470), via an unspecified route of administration on 03Apr2021 at single dose for COVID-19 immunisation. Patient medical history and concomitant medications were not reported. On 04Apr2021, the patient was vaccinated at home and found in asystole, the 118 was called. On 06Apr2021 request for a clinical report and whether an autopsy was carried out. It was unknown whether the autopsy was performed or not. The patient died due to asystole. ; Reported Cause(s) of Death: he person was vaccinated at home and found in asystole, the 118 was called and the person died.


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