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

This is VAERS ID 1340051

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Case Details

VAERS ID: 1340051 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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: 2021-01-01
   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: Cardiac failure; Chronic obstructive pulmonary disease; Liver cirrhosis; Type 2 diabetes mellitus; Vascular dementia
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: SEPFIZER INC2021554110

Write-up: ACUTE CIRCULATION CONDITION (FAILURE); This is a spontaneous report from a contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is [SE-MPA-2021-037891]. An 85-year-old male patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on Jan2021 (Lot Number: EJ6134) as 1ST DOSE, SINGLE for covid-19 immunisation. Medical history included ongoing chronic obstructive pulmonary disease, ongoing type 2 diabetes mellitus, ongoing hepatic cirrhosis, ongoing vascular dementia, ongoing cardiac failure. The patient''s concomitant medications were not reported. The patient experienced acute circulation condition in Jan2021 with fatal outcome. Patient was die in Jan2021. Patient was entirety an elderly, multi-sick man, who received the vaccine the day before death. Unclear causal relationship. But report due to new vaccine. The patient died on Jan2021. It is unknown if autopsy was done. No follow-up attempts are possible. No further information is expected. Information about batch number already obtained. ; Reported Cause(s) of Death: Acute circulatory failure

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