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

This is VAERS ID 1339158

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Case Details

VAERS ID: 1339158 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-14
Onset:2021-04-28
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW4815 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Decreased appetite, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

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:
Current Illness: Lymphoma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: HUPFIZER INC2021560188

Write-up: sudden death; weakness; inappetence; This is a spontaneous report from a contactable physician downloaded from the Medicines Agency (MA) -WEB, regulatory authority number HU-OGYI-290921. An 89-year-old male patient received bnt162b2 (Pfizer vaccine), dose 2 intramuscular, administered in arm left on 14Apr2021 (Lot Number: EW4815) as 0.3 ml, single dose for covid-19 immunisation. Medical history included ongoing lymphoma. The patient previously received first dose of bnt162b2 (batch number: EP2163) intramuscularly, in the left arm at 0.3 ml on an unspecified date for covid-19 immunisation. The patient''s concomitant medications were not reported. The patient experienced sudden death on 28Apr2021. The patient experienced weakness and inappetence in the period before death. The patient died on 28Apr2021. In the reporter physician opinion, the causal relationship between the reported death and the vaccine is unlikely. The outcome of weakness and inappetence was unknown. The autopsy was initiated at the time of the report. Results are not available. Sender comments: The 89- year-old patient died 14 days after Pfizer vaccination. The cause of death was unknown. Dechallenge and rechallenge were not applicable. The causal relationship between the reported death and the vaccine is not assessable. The case is serious due to fatal outcome. No follow-up attempts possible. No further information expected; Reported Cause(s) of Death: sudden death


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