On 21 July 2022, one minute after takeoff from Surabaya, an Airbus A320 First Officer acting as Pilot Flying saw that their Captain was “in a rigid position”. A medically qualified passenger was identified but could not identify signs of life. A ‘PAN’ was declared and a return to land requested but due to resuscitation attempts, it was over 40 minutes before a landing occurred. The Captain was subsequently confirmed deceased. The Captain’s most recent medical examination was found not to have led to a sufficiently in-depth assessment of his ongoing vascular risk factors before renewal of his medical certification.