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

This is VAERS ID 1231931

Case Details

VAERS ID: 1231931 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Circulatory collapse, Drug ineffective, Respiratory tract infection viral, Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Lack of efficacy/effect (narrow), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Arterial hypertension; Chronic renal insufficiency; Coronary heart disease; Type 2 diabetes mellitus
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021409172

Write-up: cardiovascular failure/Sudden cardiac death; cardiovascular failure/Sudden cardiac death; COVID-19; COVID-19; Viral infection of the respiratory tract; This is a spontaneous report from a non-contactable consumer downloaded from the Medicines Agency (MA) -WEB, regulatory authority number DE-PEI-CADR2021044779, Safety Report Unique Identifier DE-PEI-202100032482. A 74-year-old female patient received bnt162b2 (Pfizer vaccine, Solution for injection), intramuscular on 24Feb2021 (Lot Number: EP9598) as single dose for covid-19 immunisation. Medical history included ongoing Chronic renal insufficiency, ongoing Coronary heart disease, ongoing Arterial hypertension, ongoing Type 2 diabetes mellitus. The patient''s concomitant medications were not reported. The patient''s weight was 72 kg, and height was 156 cm. On 08Mar2021, the patient experienced Viral infection of the respiratory tract, COVID-19. On 09Mar2021, the patient experienced cardiovascular failure/Sudden cardiac death. The patient died on 09Mar2021. No autopsy was performed. It was reported that Information on risk factors or previous illnesses arterial hypertension, coronary heart disease, Diabetes mellitus type 2, chronic renal insufficiency / one day before death in general. physical weakness, Pulmo exacerbated vesicular breathing. No concerned have any allergies. Relatedness of drug to reactions was assessed as D. Unclassifiable by PEI. The outcome of the events cardiovascular failure/Sudden cardiac death was fatal, of the other events was not recovered. No follow-up attempts are possible. No further information is expected. ; Reported Cause(s) of Death: cardiovascular failure; Sudden cardiac death

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