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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1380181

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Case Details

VAERS ID: 1380181 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-18
Onset:2021-04-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX0893 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood test, C-reactive protein, Culture, Fibrin D dimer, Muscle enzyme, Myocardial infarction, Procalcitonin, Septic shock, Syncope, Thrombocytopenia, Troponin, White blood cell count
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Toxic-septic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Arteriovenous fistula; Chronic hemodialysis (with left proximal arteriovenous fistula); Coronary bypass (triple coronary artery bypass); Diabetic peripheral vascular disease; Hypertension; Percutaneous transluminal angioplasty; Toe amputation
Allergies:
Diagnostic Lab Data: Test Date: 20210420; Test Name: Blood test; Result Unstructured Data: Test Result:positive for E.coli; Test Date: 20210420; Test Name: C-reactive protein; Result Unstructured Data: Test Result:1.20; Test Date: 20210420; Test Name: bronchial culture; Result Unstructured Data: Test Result:positive for Candida spp.; Test Date: 20210421; Test Name: D-dimers; Result Unstructured Data: Test Result:significantly altered; Test Date: 20210421; Test Name: muscular enzymes; Result Unstructured Data: Test Result:significantly altered; Test Date: 20210421; Test Name: procalcitonin; Result Unstructured Data: Test Result:significantly altered; Test Date: 20210420; Test Name: Platelets; Result Unstructured Data: Test Result:thrombocytopenia; Test Date: 20210421; Test Name: troponin; Result Unstructured Data: Test Result:significantly altered; Test Date: 20210330; Test Name: white blood cells; Result Unstructured Data: Test Result:5.540; Comments: /mm3; Test Date: 20210420; Test Name: white blood cells; Result Unstructured Data: Test Result:1.410; Comments: /mm3
CDC Split Type: ITPFIZER INC2021590835

Write-up: Septic shock; suspected myocardial infarction; syncope; thrombocytopenia; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB IT-MINISAL02-731595. A 64-year-old male patient received first dose of BNT162B2 (COMIRNATY) Lot number EX0893, expiration date 31Jul2021, Intramuscular in right arm on 18Apr2021 09:30 at single dose for COVID-19 immunisation. Medical history included Diabetic peripheral vascular disease, triple coronary artery bypass, Hypertension, Toe amputation, Diabetes mellitus from 01Jan1980 to 25Apr2021, Chronic hemodialysis with left proximal arteriovenous fistula and Percutaneous transluminal angioplasty. Concomitant medication was not reported. The patient had Covid-19 vaccination on 18Apr2021, patient in good clinical condition also on 20Apr2021 (dialysis in the morning) then in the evening access to the emergency room for syncope, with subsequent hospitalization for suspected myocardial infarction and then resuscitation for septic shock; positive blood culture for E. coli, culture of bronchoaspirate positive for Candida spp on 20Apr2021 (rare). Died on 25Apr2021. Treatment received included In resuscitation room antibiotic therapy, intubated, supported by amines, treated with continuous dialysis (CVVH - Continuous Veno-Venous Hemofiltration). Lab data on 30Mar2021 white blood cells 5,540 / mm3; on 20Apr2021 white blood cells 1,410 / mm3 with thrombocytopenia CRP 1.20 mg / dL; From 21Apr2021 significant alteration of muscle enzymes, D-Dimer, procalcitonin and troponin. Reporter''s comments: Covid-19 vaccination on 18Apr2021, patient in good clinical condition also on 20Apr2021 (dialysis in the morning) then in the evening access to the emergency room for syncope, with subsequent hospitalization for suspected myocardial infarction and then resuscitation for septic shock; positive blood culture for E. coli, culture of bronchoaspirate positive for Candida spp on 20Apr2021 (rare). Died on 25Apr2021. Sender''s comments: 19May2021 Head of Pharmacovigilance requested detailed report with previous medical history. Asked if autopsy exam available. Waiting; Reporter''s Comments: Covid-19 vaccination on 18Apr2021, patient in good clinical condition also on 20Apr2021 (dialysis in the morning) then in the evening access to the emergency room for syncope, with subsequent hospitalization for suspected myocardial infarction and then resuscitation for septic shock; positive blood culture for E. coli, culture of bronchoaspirate positive for Candida spp. (rare). Died on 25Apr2021.; Reported Cause(s) of Death: Septic shock; suspected myocardial infarction


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