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

This is VAERS ID 1304884

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Case Details

VAERS ID: 1304884 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021496800

Write-up: Sudden death; This is a spontaneous report received from a contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is NL-LRB-00524561. A 69-year-old male patient received the BNT162B2 (COMIRNATY, batch/lot number and expiration date not provided), via an unspecified route of administration, on 26Apr2021, at 0.3 mL single dose, for COVID-19 immunization. Medical history and concomitant medications were not reported. No previous COVID-19 infection. The patient experienced sudden death on 29Apr2021, no symptoms prior to death. The outcome of the event was fatal. The cause of death was not reported. Autopsy was performed and no results available. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: sudden death

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