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

This is VAERS ID 1345171

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Case Details

VAERS ID: 1345171 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-02
Onset:2021-05-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET7205 / 2 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Headache, 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: 2021-05-02
   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: Cerebral haemorrhage (with resentment of the left hemisoma but with discrete autonomy); Diabetes; Hypertension; Lymphoma (at the age of 80); Venous thrombosis (Previous venous or nail thrombosis)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021579546

Write-up: Sudden death/instant death; Severe headache appeared, followed by almost instant death; This is a spontaneous report from a contactable consumer or other non hcp downloaded from a regulatory authority-WEB, regulatory authority number IT-MINISAL02-730302. A 93-year-old male patient received second dose of BNT162B2 (COMIRNATY, Formulation: Solution for injection, Lot number: ET7205, expiration date not reported) intramuscularly administered on right arm on 02Apr2021 as a 2nd dose, 0.3 ml single for COVID-19 immunisation. The patient medical history included diabetes, hypertension, previous venous or nail thrombosis, previous cerebral haemorrhage (2018) with resentment of the left hemisoma but with discrete autonomy, lymphoma at the age of 80. The patient concomitant medications were not reported. On an unknown date, the patient previously received first dose of BNT162B2 (COMIRNATY, Formulation: Solution for injection, Batch/Lot number: not reported) via unspecified route of administration as 1st dose, single for COVID-19 immunisation. The patient had no adverse reaction during 1st dose of Comirnaty vaccine. On 02May2021(one month after the 2nd dose), the patient experienced severe headache, followed by almost instant death. After consulting the attending physician, he reported the symptoms as the cause of death given the symptoms: sudden death from cerebral haemorrhage, probable recurrence of cerebral haemorrhage which occurred in 2018 in an elderly patient with multiple pathologies-COVID 19 COMIRNATY VACCINE (PFIZER): Administration site (right shoulder) Booster dose number (2). It was unknown if autopsy was performed or not. The outcome of the events was fatal. Reporter Comment: Diabetes, hypertension, previous venous or nail thrombosis, previous cerebral haemorrhage (2018) with resentment of the left hemisoma but with discrete autonomy, lymphoma at the age of 80. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Cerebral haemorrhage


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