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

This is VAERS ID 1588699

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Case Details

VAERS ID: 1588699 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-20
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE6975 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC202101045257

Write-up: Sudden cardiac death; This is a spontaneous report downloaded from the Regulatory Authority-WEB WWID reported as Regulatory Authority Number DE-PEI-202100161882 from the Healthcare Authority. A 56 years old male patient received bnt162b2 (COMIRNATY, lot FE6975) on 20Jul2021 single dose for COVID-19 immunisation at the age of 55 years old. Medical history and concomitant drugs were not provided. The patient experienced Sudden cardiac death on unknown date. Outcome of the event was fatal. It was unknown if autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Sudden cardiac death


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