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

This is VAERS ID 1347959

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Case Details

VAERS ID: 1347959 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-04
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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: 2021-01-01
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC2021566035

Write-up: Cardio-respiratory arrest; This is a spontaneous report received from a contactable consumer or other non-healthcare professional downloaded from the Regulatory Authority (RA)-WEB. The regulatory authority report number is ES-AEMPS-736198. A male patient of an unspecified age received BNT162B2 (COMIRNATY), via an unspecified route of administration on 04Jan2021 at single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient died of cardio-respiratory arrest in Jan2021 within 24 hours of having the vaccine administered. The patient died in Jan2021. It was unknown if an autopsy was performed. The reporter wanted to know why the reporter was not able to see in the report from the agency on adverse reactions reported in the area from 27Dec2020 to 12Jan2021, those who died after having the vaccine administered. The health center to which the reporter''s deceased uncle belonged informed reporter that they would notify the agency and, consulting the report, the reporter did not find any deaths, when the reporter''s uncle died of cardio-respiratory arrest within 24 hours of having the vaccine administered. Any explanation why the case was not included in the report, please. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Cardio-respiratory arrest


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