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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1365222



Case Details

VAERS ID: 1365222 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-05-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Work       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: 2021-05-15
   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: Edarbi
Current Illness:
Preexisting Conditions: Obesity, high blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received the shot 5/6 and very unexpectedly died 5/15, autopsy was not performed because foul play was not suspected and family could not pay to have it done


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1365222

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