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

This is VAERS ID 1298611

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Case Details

VAERS ID: 1298611 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-20
Onset:2021-04-25
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

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: 2021-04-25
   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: DILTIAZEM; CLOPIDOGREL; COZAAR PLUS; PLAQUENIL S; SIMVASTATINE; QUETIAPINE; PANTOPRAZOLE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021491371

Write-up: possible acute cardiac death; This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB, regulatory authority number NL-LRB-00521326. An 80-year-old male patient received bnt162b2 (COMIRNATY), dose 2 via an unspecified route of administration on 20Apr2021 (Batch/Lot Number: Unknown) as single dose for COVID-19 immunization. The patient medical history was not reported. Concomitant medication included diltiazem; clopidogrel; hydrochlorothiazide, losartan potassium (COZAAR PLUS); hydroxychloroquine sulfate (PLAQUENIL S); simvastatine; quetiapine; pantoprazole, all taken for an unspecified indication, start and stop date were not reported. On 25Apr2021, the patient experienced possible acute cardiac death. The patient died on 25Apr2021. An autopsy was not performed. Reporter''s comments: Previous COVID-19 infection: No. Other diagnostic procedures: no. Past drug therapy : covid-19 vaccin pfizer injvlst with no adverse reaction. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: possible acute cardiac death


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