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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1367997



Case Details

VAERS ID: 1367997 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-05-07
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Electrocardiogram abnormal, Laboratory test, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   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: Vitamins, hormones, IBS drugs
Current Illness: IBS, diverticulitis
Preexisting Conditions: IBS
Allergies: None
Diagnostic Lab Data: Taken to the ER and admitted, many tests taken to rule out brain stroke. EKG proved massive heart attack.
CDC Split Type:

Write-up: Massive Heart Attack resulting in death.


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