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

This is VAERS ID 1338069

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Case Details

VAERS ID: 1338069 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-27
Onset:2021-05-10
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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: 2021-05-10
   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: Non-smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC2021553656

Write-up: Sudden death; This is a spontaneous report from a contactable consumer or other non hcp downloaded from the regulatory authority, ES-AEMPS-861158. A 64-year-old male patient received BNT162b2 (COMIRNATY, Solution for injection, Lot number- UNKNOWN) via an unspecified route of administration in arm on 27Apr2021 as 1st dose single for COVID-19 immunization. Patient medical history included that the patient had no known pathologies and was a non-smoker, athlete and concomitant medications were not reported. A family member reported that the patient had not been infected by COVID-19. On 10May2021 (as reported) Death occurred at night, two weeks after vaccination. It was classified as cardiorespiratory arrest. The judge has denied the autopsy request, despite the fact that the family doctor requested it, on suspicion that vaccination may have played some role in the outcome. The outcome of the event was fatal. No follow-up attempts are possible, information on batch number cannot be obtained.; Reported Cause(s) of Death: Cardio-respiratory arrest


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