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

This is VAERS ID 1241462



Case Details

VAERS ID: 1241462 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-17
Onset:2021-03-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Aortic dissection, Blood pressure measurement, Cardiac failure, Peripheral circulatory failure
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:high; Comments: well controlled
CDC Split Type: DEPFIZER INC2021420798

Write-up: Collapse circulatory peripheral; Aortic dissection Exitus letalis; death after aortic dissection; This is a spontaneous report from a non-contactable consumer downloaded from the regulatory authority, regulatory authority number DE-PEI-CADR2021046597. A 77-years-old male patient received bnt162b2 (COMIRNATY), intramuscular on 17Mar2021 (Batch/Lot Number: Unknown) as 0.3 mL, single for covid-19 immunisation. Medical history included ongoing hypertension. Person was not concerned known of any allergies. The patient''s concomitant medications were not reported. The patient experienced aortic dissection exitus letalis on 18Mar2021, death after aortic dissection on 18Mar2021, collapse circulatory peripheral on 18Mar2021. The patient underwent lab tests and procedures which included blood pressure measurement: high with well controlled. The patient died on 18Mar2021. It was not reported if an autopsy was performed. Outcome of heart failure and aortic dissection was fatal, of peripheral circulatory failure was not recovered.Well controlled high blood pressure / one day after vaccination retrosternal. Pain, emergency in clinic, and Circulatory failure and death. Seriousness criteria of heart failure and aortic dissection was death, of others was hospitalized. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: Cardiac failure


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