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

This is VAERS ID 1328853

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Case Details

VAERS ID: 1328853 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET6956 / 1 - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   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: INSULIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac fibrillation; Diabetes mellitus; Heart failure; Obesity (BMI=31)
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021539531

Write-up: Died within 4 hours; This is a spontaneous report from a contactable other hcp downloaded from the Regulatory Authority -WEB [NL-LRB-00535361]. A 69-year-old male patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on 28Apr2021 (Batch/Lot Number: ET6956) as 1st dose, single for covid-19 immunisation; Acenocoumarol via an unspecified route of administration from 2020 to 28Apr2021, according to scheme for an unspecified indication. Medical history included diabetes mellitus, obesity (BMI=31), heart failure, cardiac fibrillation from 2020. No Previous COVID-19 infection. Concomitant medication included Insulin. The patient experienced died within 4 hours (Heart attack) on 28Apr2021. Action taken for Acenocoumarol was unknown. The outcome of heart attack is fatal. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected. ; Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty) Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): no confounding factors confounding factors: Diabetes and heart failure COVID-19 Previous COVID-19 infection: No.; Reported Cause(s) of Death: Died within 4 hours


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