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

This is VAERS ID 1378611

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Case Details

VAERS ID: 1378611 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-03
Onset:2021-05-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW6126 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram, Loss of consciousness, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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: SPIRIVA; PANODIL; IBUMETIN; SPARKAL MITE; LETROZOL ACCORD; ENALAPRIL KRKA; ZOLEDRONIC ACID FRESENIUS KABI
Current Illness: Breast cancer (surgery for breast cancer); Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer surgery; Chronic obstructive pulmonary disease; Pain
Allergies:
Diagnostic Lab Data: Test Date: 20210507; Test Name: EKG; Result Unstructured Data: Test Result:PEA (Pulseless electrical activity)
CDC Split Type: DKPFIZER INC2021628194

Write-up: Heart attack; The patient has during a walk suddenly collapsed and is uncontactable; This is a spontaneous report from a contactable pharmacist and two physicians downloaded from -WEB (Regulatory Authority number DK-DKMA-WBS-0065634, Safety Report Unique Identifier DK-DKMA-ADR 25273181). A 75 years old female patient received the second single dose of BNT162B2 (COMIRNATY; lot/batch EW6126, expiry date Jul2021) intramuscular, on 03May2021, for COVID-19 immunisation. Medical history included ongoing breast cancer (surgery for breast cancer), ongoing hypertension, pain and chronic obstructive pulmonary disease. The first dose of Comirnaty was administered on 12Apr2021 (lot number: EW4811 Expiration date: 31Jul2021) for COVID-19 immunisation. Concomitant medications included tiotropium bromide (SPIRIVA; 18 ug) from 2017, 1 DF, 1x/day, for COPD, paracetamol (PANODIL; 500 mg tablet) from 17Feb2017, 1000 mg, as needed, max 4 times daily, for pain, ibuprofen (IBUMETIN; 400 mg tablet) from 28Oct2019, 400 mg, as needed, max 3 times daily, for pain, amiloride hydrochloride, hydrochlorothiazide (SPARKAL MITE) from 09Apr2021, 1 DF, 1x/day, for hypertension, letrozole (LETROZOL ACCORD; 2.5 mg tablet) from 18Sep2018, 2.5 mg, 1x/day, for breast cancer, enalapril maleate ENALAPRIL KRKA 10 mg tablet) 10 mg, 1x/day, for hypertension, zolendronic acid (ZOLEDRONIC ACID FRESENIUS KABI) from 09Dec2019, for breast cancer. On 07May2021 the patient experienced heart attack and during a walk suddenly collapsed and was uncontactable. The events were reported by both reporters as fatal (date of death 07May2021). Resuscitation has been attempted and adrenaline was given. The patient was dead on arrival at hospital. Reported cause of death: heart attack. It was unknown if an autopsy was actually performed, however it was reported that autopsy will be performed (result was awaiting). EKG (electrocardiogram): PEA (Pulseless electrical activity) on 07May2021. COMMENT FROM a regulatory authority: Two reporters have simultaneously submitted on the same patient-drug reaction. Duplicate case DK-DKMA-WBS-0065669 (DK-DKMA-ADR 25275940) has been merged with this master case before submission to a regulatory authority. A regulatory authority should therefore consider version 2 of the master as the initial report. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Heart attack


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