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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1328852

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Case Details

VAERS ID: 1328852 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-11
Onset:2021-05-03
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET9096 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Echocardiogram, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Cardiac ultrasound; Result Unstructured Data: Test Result:Unknown results
CDC Split Type: NLPFIZER INC2021539480

Write-up: Cardiac arrest; Myocardial infarction; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB NL-LRB-00534918, received from Regulatory Authority. A 74-year-old male patient received first dose of bnt162b2 (COMIRNATY), via an unspecified route of administration on 11Apr2021 (Batch/Lot Number: ET9096) as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Patient didn''t have COVID-19 infection previous. The patient experienced cardiac arrest on 03May2021, Myocardial infarction (Heart attack) followed by cardiac arrest. Cardiac ultrasound in emergency room hospital. Both events treated with Reanimatie. The outcome of cardiac arrest and heart attack was fatal. Patient died on 03May2021. It was unknown if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Myocardial infarction; Cardiac arrest


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