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

This is VAERS ID 1227977



Case Details

VAERS ID: 1227977 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Laboratory test, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Colon cancer
Allergies:
Diagnostic Lab Data: Test Date: 2011; Test Name: lab work; Result Unstructured Data: Test Result:Good
CDC Split Type: USPFIZER INC2021406385

Write-up: Pulmonary embolism/ blood clot/ passed out; This is a spontaneous report from a contactable consumer (patient''s daughter). A male patient of an unspecified age received BNT162B2 (Pfizer COVID-19 vaccine), dose 1 via an unspecified route of administration, administered in arm, side unknown, on 24Mar2021 14:30 (Lot Number: EN6208) as single dose for COVID-19 immunisation. Vaccination facility type was clinic. Medical history included colon cancer in 2011. He had cancer in 2011 but resolved that year without chemotherapy or radiation. His lab work was good. There were no concomitant medications. No prior vaccinations (within 4 weeks). No family medical history relevant to AE. The patient experienced pulmonary embolism on 26Mar2021 with fatal outcome. The reporter was reporting on the Pfizer COVID vaccine that her father received. She stated he died from a blood clot after receiving the first dose. Stated she needs help because he had no health issues and he died. She just wanted this information to be out there and for people to be aware. This morning they had been reading on the news that the Johnson and Johnson vaccine is on hold. It seems to be put on the market without research. She felt like her father was a guinea pig. Her mother didn''t want to get her second dose. Stated there seems to be an issue with Pfizer too. Her father had no issues whatsoever. His death certificate stated the cause of death was a pulmonary embolism, but he had no history of blood clots. Passed away Friday 26Mar2021 at 11:33 am. The reporter stated when he went to Emergency Room they thought he was having a heart attack. All physicians were wondering what happened because he had no health issues. The event required a visit to the emergency room that day because he passed out at his job. The patient underwent lab tests and procedures which included lab work: good in 2011. The patient died on 26Mar2021. An autopsy was performed that revealed pulmonary embolism.; Reported Cause(s) of Death: Pulmonary embolism; Autopsy-determined Cause(s) of Death: Pulmonary embolism


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