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

This is VAERS ID 1339303

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Case Details

VAERS ID: 1339303 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-10
Onset:2021-05-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5831 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   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: LEVETIRACETAM; PHENOBARBITAL; LANSOPRAZOLE
Current Illness: Paralytic disability
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021560707

Write-up: Cardio-respiratory arrest; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB IT-MINISAL02-728694 A 65-year-old female patient received the first dose of BNT162B2 (COMIRNATY, lot number: FA5831 and expiration date: 31Aug2021), via intramuscular, in arm left, on 10May2021 12:10, at 0.3 mL single dose, for COVID-19 immunization. Medical history included paralytic disability from 14Nov2014 to 11May2021. Concomitant medications included levetiracetam, phenobarbital and lansoprazole. The patient experienced cardio-respiratory arrest (fatal) on 11May2021. The outcome of the event was fatal. Patient died on 11May2021. It was not reported if an autopsy was performed. Reporter comment: From the administration of the drug to the patient''s exit, there is no evidence of specific symptoms (patient in a vegetative state); Reported Cause(s) of Death: Cardio-respiratory arrest


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