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

This is VAERS ID 1380206

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Case Details

VAERS ID: 1380206 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Cardiomyopathy; Thyroidectomy
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021628334

Write-up: Respiration failure; probable cardiac arrest; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB, regulatory authority number IT-MINISAL02-735059. A 68-year-old female patient received second dose of BNT162B2 (COMIRNATY), intramuscular, administered in arm right on 11May2021 (Batch/Lot Number: FA5831) as 0.3 mL single dose for COVID-19 immunisation. Medical history included cardiopathic, thyroidectomy and atrial fibrillation, all from an unknown date and unknown if ongoing. Concomitant medications included ramipril taken for an unspecified indication; atorvastatin taken for an unspecified indication; escitalopram oxalate taken for an unspecified indication; levothyroxine sodium (EUTIROX) taken for thyroidectomy; dabigatran etexilate mesilate (PRADAXA, formulation: capsule hard, strength: 150 mg) oral at 300 mg daily taken for atrial fibrillation and bisoprolol fumarate taken for an unspecified indication, for all concomitants start and stop date were not reported. The patient previously received first dose of BNT162B2 (COMIRNATY), on an unspecified date (Batch/Lot Number were not reported) the patient experienced no adverse event. The patient experienced respiratory failure on 19May2021 rescuers have reached the resuscitation with cardiac massage but must ascertain his death, due to probable cardiac arrest. The patient died on 19May2021. It was not reported if an autopsy was performed. Sender Comment: contacted by telephone at the reporter due to the impossibility of finding the person in charge, additional information was entered when entering the form. Follow-up will be carried out with the doctor regarding the clinical history. Reporter Comment: Cardiopathic subject, who died of probable cardiac arrest, date of second vaccine dose 11May, date of death 19May.; Reporter''s Comments: Cardiopathic subject, who died of probable cardiac arrest, date of second vaccine dose 11May, date of death 19May; Reported Cause(s) of Death: Respiration failure; cardiac arrest

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