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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1418559

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Case Details

VAERS ID: 1418559 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-23
Onset:2021-05-06
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW2239 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiogenic shock
SMQs:, Cardiac failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   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: Asthma; Dementia; Embolism pulmonary; Hypertension arterial; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021697584

Write-up: Cardiogenic shock; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB FR-AFSSAPS-2021069082. A 73-year-old male patient received bnt162b2 (COMIRNATY, Lot Number: EW2239), second dose intramuscular on 23Apr2021 as 2nd dose, single for covid-19 immunization. Medical history included asthma, hypertension arterial, pulmonary embolism, dementia, type 2 diabetes mellitus all from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced cardiogenic shock on 06May2021. Cardiogenic shock on day 14 of second dose pending hospitalization CR (serum creatinine), it will be the subject of a new version. The outcome of event was fatal. The patient died on 06May2021. An autopsy was not performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Arrest cardiac


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