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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1338994

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Case Details

VAERS ID: 1338994 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-22
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: 2021-05-13
   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:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021548908

Write-up: Death sudden; This is a spontaneous report from a contactable physician from a regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202105141046542160-ORTAS and Sender''s (Case) Safety Report Unique Identifier GB-MHRA-ADR 25297408. A 41-years-old male patient received bnt162b2 (COMIRNATY), dose 2 via an unspecified route of administration in May2021 (Batch/Lot Number: EM4965) as single dose (Age at vaccination: unknown) for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Historical vaccine included COMIRNATY 1st dose, single for covid-19 immunisation. The patient experienced death sudden on 13May2021. Unsure if patient has had symptoms associated with COVID-19. Not had a COVID-19 test. Unsure if patient was enrolled in clinical trial. It is unknown if autopsy was done. No follow-up attempts possible. No further information expected. Information about batch number has been obtained. ; Reported Cause(s) of Death: Death sudden

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