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

This is VAERS ID 1375562

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Case Details

VAERS ID: 1375562 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   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: SKPFIZER INC2021617833

Write-up: Pulmonary embolism; This is a spontaneous report received from a contactable consumer (patient daughter) downloaded from the regulatory authority-WEB (Regulatory Authority number SK-SUKLSK-20214142). A 72-year-old male patient received BNT162B2 (COMIRNATY) intramuscular, on 29Mar2021, at single dose, for COVID-19 immunisation. Medical history was not reported. Concomitant medications included unspecified anticoagulants. On 14Apr2021 the patient experienced pulmonary embolism and died on the same day. The event was reported with a fatal outcome. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Pulmonary embolism

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