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

This is VAERS ID 1339155

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Case Details

VAERS ID: 1339155 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-19
Onset:2021-04-11
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Circulatory collapse
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   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: Atherosclerosis; Ischemic heart disease; Myocardial infarction; Parkinson''s disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: HUPFIZER INC2021560099

Write-up: circulatory failure; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB, regulatory authority number HU-OGYI-289821. An 81-year-old male patient received bnt162b2 (COMIRNATY, strength: 0.3 ml), dose 1 intramuscular on 19Mar2021 (Batch/Lot Number: Unknown) as 0.3 ml, single dose for covid-19 immunisation. Medical history included myocardial infarction, arteriosclerosis, Parkinson''s disease, and myocardial ischaemia, all from an unknown date to an unknown date. The patient''s concomitant medications were not reported. The patient experienced circulatory failure on 11Apr2021. Additional information: On 11Apr2021 the patient collapsed, an ambulance was called. Reanimation was unsuccessful, the patient died due to circulatory failure. Autopsy was not done. In the reporter physician''s opinion, the event is related to the patient''s underlying diseases. The patient died on 11Apr2021. Sender''s comment: The 81-year-old patient died 23 days after Comirnaty vaccination. Cause of death was circulatory failure. Autopsy was not done. In the reporter physician''s opinion, the event is related to the patient''s underlying diseases. The case is serious due to fatal outcome. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Circulatory failure


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