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

This is VAERS ID 1380214

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Case Details

VAERS ID: 1380214 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-28
Onset:2021-05-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA8016 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Cardiac arrest, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   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: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021645696

Write-up: Abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers; Abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers; Abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB, regulatory authority number IT-MINISAL02-737092. A 52-year-old male patient received first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot Number: FA8016), via intramuscular, administered in arm left (left shoulder) on 28May2021 at 13:00 as 1st dose, single dose for COVID-19 immunisation. Medical history included hypertension. The patient''s concomitant medications were not reported. On 28May2021, the patient experienced abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers. The patient died on 28May2021. It was not reported if an autopsy was performed. Outcome of the events fatal. Sender Comment: 30May2021 added clinical report Reporter''s comment: The relationship is temporal: the causal link has to be demonstrated. Body under judicial protection following a complaint by family members.; Reporter''s Comments: The relationship is temporal: the causal link has to be demonstrated. Body under judicial protection following a complaint by family members; Reported Cause(s) of Death: Consciousness loss; Abdominal pain; Arrest cardiac


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