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

This is VAERS ID 1440380

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Case Details

VAERS ID: 1440380 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: ADHD; Alcohol addiction; Depression; Drug withdrawal maintenance therapy; Fracture of ankle; Hypertension
Diagnostic Lab Data:
CDC Split Type: DKPFIZER INC2021728765

Write-up: Sudden death; This is a spontaneous report from two contactable physicians downloaded from the Agency Regulatory Authority-WEB, regulatory authority number DK-DKMA-WBS-0069958. A 55-year-old male patient received bnt162b2 (COMIRNATY), intramuscular on 27May2021 (Batch/Lot Number: FA7812) (at the age of 55-year-old) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included fracture of ankle from 17May2021, hypertension, alcohol addiction, drug withdrawal maintenance therapy, attention deficit hyperactivity disorder (ADHD), and depression. Concomitant medications included methadone taken for drug withdrawal maintenance therapy from 16Dec2020; methylphenidate hydrochloride (MOTIRON) taken for ADHD from 05Oct2020; venlafaxine taken for depression from 12Mar2019; disulfiram taken for alcohol addiction from 28Nov2019; and amlodipine taken for hypertension from 07Feb2021. On 27May2021, the patient experienced sudden death. The patient died on 27May2021. An autopsy was performed on 03Jun2021 and results were not provided. There is no information regarding test results. Causality: Police finds patient dead and contacts the patient''s physician the initial reporter who informs the police that the death was unexpected in spite of known concurrent conditions. The police believe the death to be caused by heart failure, this has not been confirmed. The physician has not seen the patient during the last period. The physician at a Regulatory authority informs that there will be performed an autopsy on 03Jun2021 due to the timing between vaccination and patient death. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: sudden death

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