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

This is VAERS ID 1241418



Case Details

VAERS ID: 1241418 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER9480 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Pulmonary embolism, SARS-CoV-2 test
SMQs:, Embolic and thrombotic events, venous (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   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: METOPROLOL; COVERAM; SERETIDE; SPIRIVA HANDIHALER; LORMETAZEPAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COPD; Hypertension; Obesity
Allergies:
Diagnostic Lab Data: Test Date: 202104; Test Name: Covid test; Test Result: Positive ; Comments: After death COVID positivity determined
CDC Split Type: BEPFIZER INC2021420699

Write-up: Acute pulmonary embolism resulting in death; COVID positivity; This is a spontaneous report received from a contactable physician downloaded from the regulatory authority. The regulatory authority report number is BE-FAMHP-DHH-N2021-87195. An 81-years-old male patient received first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 01Apr2021 (Lot Number: ER9480) as single dose for COVID-19 vaccination. Medical history included COPD, hypertension and obesity. Concomitant medication(s) included metoprolol; amlodipine besilate, perindopril arginine (COVERAM); fluticasone propionate, salmeterol xinafoate (SERETIDE); tiotropium bromide (SPIRIVA HANDIHALER); lormetazepam. The patient experienced acute pulmonary embolism resulting in death on 02Apr2021. There was no treatment. After death COVID positivity determined (Apr2021). The patient died on 02Apr2021. An autopsy was performed and results were not provided. The outcome of COVID positivity was unknown. Reporter''s comments: Treatment - No Evolution of the ADR - Deceased Examinations - autopsy performed After death COVID positivity determined No follow-up attempts possible. No further information expected. Reported Cause(s) of Death: acute pulmonary embolism


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