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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1297195

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Case Details

VAERS ID: 1297195 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-08
Onset:2021-04-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW8904 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Coronary artery disease NOS; Dementia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC2021496487

Write-up: Sudden cardiac death; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority, company number DE-PEI-202100051722. A 64-year-old male patient received bnt162b2 (COMIRNATY, lot number: EW8904), via an unspecified route of administration on 08Apr2021 (at the age of 64-years-old) as a single dose for covid-19 immunisation. The patient medical history included ongoing coronary artery disease NOS and ongoing dementia. The patient''s concomitant medications were not reported. The patient experienced sudden cardiac death on 13Apr2021. The outcome of the event was fatal. The patient died on 13Apr2021. Cause of death was sudden cardiac death. An autopsy was not performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Sudden cardiac death


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