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

This is VAERS ID 1236489



Case Details

VAERS ID: 1236489 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET7205 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: Cardiac arrhythmia (NOS); Failure kidney (on dialysis); Type II diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CZPFIZER INC2021414911

Write-up: Myocardial infarction; This is a spontaneous report received from a contactable consumer downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is CZ-CZSUKL-21003913. An 80-year-old (also reported as "76-year-old") male patient received the second dose (dose 2) of BNT162B2 (COMIRNATY), via intramuscular (IM) on 01Apr2021 (Lot Number: ET7205) as single dose for covid-19 immunisation. Medical history included ongoing Type II diabetes mellitus, ongoing failure kidney on dialysis, ongoing cardiac arrhythmia (NOS). There were no concomitant medications. The patient received the first dose of BNT162B2 (COMIRNATY), via intramuscular on 04Mar2021 (lot number unknown) as single dose for covid-19 immunisation. The patient experienced myocardial infarction on 01Apr2021. The event reported as serious and caused death outcome, hospitalization, medically significant, life threatening. The patient was hospitalized for myocardial infarction from 01Apr2021. Myocardial infarction 45 minutes after the administration of the 2nd dose of vaccine. The patient has never had an infarction before. After the repeated resuscitation and subsequent operation, the patient died on 01Apr2021 due to myocardial infarction. An autopsy was not performed. ; Reported Cause(s) of Death: Myocardial infarction


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