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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1304622

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Case Details

VAERS ID: 1304622 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-10
Onset:2021-04-25
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW2246 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart disease, unspecified
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021501426

Write-up: Administration of the first Pfizer vaccine dose on 10Apr2021. On 25Apr2021 he suddenly fainted and rescuers who intervened within 10 minutes tried to revive him for 30 minutes.; This is a spontaneous report from a contactable consumer downloaded from the Agency Regulatory Authority-WEB [IT-MINISAL02-722534]. A 76-year-old male patient received the first dose of BNT162B2 (COMIRNATY, Lot#: Ew2246) via intramuscular at 0.3 ml single on 10Apr2021 from 10:00 to 11:00 in right arm for COVID-19 immunisation. Medical history included heart disease. Concomitant medication was not reported. Administration of the first Pfizer vaccine dose on 10Apr2021. On 25Apr2021, Sunday morning, patient suddenly fainted and rescuers who intervened within 10 minutes tried to revive him for 30 minutes. The general practitioner, who had been contacted, excluded that it may have been caused by the vaccine. He hypothesized an ischemia, an embolism or rupture of the aorta. Patient suddenly lost consciousness and rescuers, who intervened within 10 minutes, tried to revive him for 30 Min, even with a defibrillator. Patient died in Apr2021. He took medications regularly and specific tests every 6 months. On 30Apr2021, the emergency report sent by the reporter who contacted communicates: No autopsy was performed because he died at home and the doctor who declared the death did not ask us for anything. The outcome of event was fatal. Reporter comment: heart disease No follow-up attempts possible. No further information expected.; Reporter''s Comments: heart disease; Reported Cause(s) of Death: lost consciousness


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