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

This is VAERS ID 1428289

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Case Details

VAERS ID: 1428289 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Chest pain, Electrocardiogram, Investigation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   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: Anxiety disorder
Diagnostic Lab Data: Test Name: ECGs; Result Unstructured Data: Test Result:normal previous ECGs; Comments: normal previous ECGs; Test Date: 202102; Test Name: Medical visit; Result Unstructured Data: Test Result:Nothing to report; Comments: Nothing to report
CDC Split Type: FRPFIZER INC2021687980

Write-up: death due to cardio respiratory arrest; pain in the chest; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB, regulatory authority number FR-AFSSAPS-MA20212207, Safety Report Unique Identifier FR-AFSSAPS-2021068966. A 38-year-old male patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection), via intramuscular on 01Jun2021 (at 38 years old, Lot Number: FC2229) as a single dose for covid-19 immunization. Medical history included anxiety disorder. The patient''s concomitant medications were not reported. The patient previously took alprazolam for anxiety disorder. Medical visit in February 2021: Nothing to report, normal previous ECGs. Sick leave the previous week for anxiety, supported by ALPRAZOLAM for 15 days. On 01Jun2021, he received a first injection of COMIRNATY no problem immediately following the vaccination and after the 15-minute monitoring. On 03Jun2021, pain in the chest after 40 minutes of running and death due to cardio-respiratory arrest. For the declaring physician, there is another medical explanation than the vaccination for the manifestations observed: autopsy requested. The outcome of the events was fatal. It was unknown if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: cardio respiratory arrest; pain in the chest

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