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

This is VAERS ID 1318088

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Case Details

VAERS ID: 1318088 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Heart rate
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   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:
Allergies:
Diagnostic Lab Data: Test Name: Initial rhythm; Result Unstructured Data: Test Result:ventricular fibrillation
CDC Split Type: DEPFIZER INC2021527597

Write-up: Death of unknown origin, two days after initial vaccination with Pfizer vaccine, according to the patient''s partner.; This is a spontaneous report from a non-contactable consumer downloaded from the Medicines Agency (MA) -WEB. Regulatory authority number is DE-PEI-CADR2021062133. Safety report unique identifier DE-PEI-202100054490. A 47-year-old male patient received the first dose of the bnt162b2 (Pfizer vaccine), via an unspecified route of administration on 30Apr2021 at 0.3ml, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced death of unknown origin, two days after initial vaccination with bnt162b2, according to the patient''s partner on 02May2021. The patient died on 02May2021 due to unknown cause. It was not reported if an autopsy was performed. Relatedness of vaccine to reaction as per PEI was assessed as unclassifiable. Sender Comment: Patient collapsed unobserved while going to the toilet. No resuscitation. Initial rhythm was ventricular fibrillation. Subsequent resuscitation and attempt at ECMO. Patient died of yet unknown cause. No follow-up attempts possible. No further information expected. Information on lot and batch numbers cannot be obtained.; Reported Cause(s) of Death: Unknown cause of death


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