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From the 5/7/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 953501

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Case Details

VAERS ID: 953501 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2020-12-16
Onset:2020-12-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ0553 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Death, Fall
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), Accidents and injuries (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-21
   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: ISTIN; ; ;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021023371

Write-up: cardiac arrest; suddenly went funny colour, odd noise, and fell back in chair; suddenly went funny colour, odd noise, and fell back in chair; Death; This is a spontaneous report received from a contactable physician from the Medicines and Healthcare products Regulatory Agency (MHRA). The regulatory authority report number is GB-MHRA-WEBCOVID-20210109135858 and GB-MHRA-ADR 24575544. An 88-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot number: EJ0553), via an unspecified route of administration, on 16Dec2020 at a single dose for COVID-19 vaccination. The patient''s medical history was not reported. Concomitant medications included amlodipine besilate (ISTIN), propranolol (MANUFACTURER UNKNOWN) taken for anxiety from 17Dec2020, levothyroxine (MANUFACTURER UNKNOWN), and ramipril (MANUFACTURER UNKNOWN). The patient previously received the influenza vaccine (reported as flu vaccine; MANUFACTURER UNKNOWN) for immunization on 07Oct2020. The patient suddenly went funny colour, odd noise, and fell back in chair and experienced cardiac arrest on an unspecified date. The patient experienced death on 21Dec2020, which was reported as fatal. The clinical course was reported as follows: The patient was well and suddenly went funny colour, odd noise, and fell back in chair. The emergency services were called and taken in cardiac arrest. The patient died in the emergency department. The patient had not had symptoms associated with COVID-19. The patient was not enrolled in a clinical trial. The clinical outcome of suddenly went funny colour, odd noise, and fell back in chair was unknown and of cardiac arrest and death was fatal. The patient died on 21Dec2020. The cause of death was reported as cardiac arrest. It was unknown if an autopsy was performed. It was also reported that since the vaccination, the patient had not been tested for COVID-19. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: cardiac arrest


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