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This is VAERS ID 1057626

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1057626
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2020-12-20
Onset:2020-12-01
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ0553 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Back pain, Cardiac arrest, Chest pain, Costochondritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Costochondritis; Joint prosthesis replacement; Knee osteoarthritis; Megaloblastic anaemia NOS; Osteoarthritis; Comments: Megaloblastic anaemia NOS TKR -Total prosthetic replacement of knee joint using cement TKR -Total prosthetic replacement of knee joint using cement TKR - Other total prosthetic replacement of knee joint Knee osteoarthritis NOS Patient has not had symptoms associated with COVID-19 Not had a COVID-19 test Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBPFIZER INC2021177037

Write-up: chest pain / left sided chest pain; costochondritis; cardiac arrest; back pain; This is a spontaneous report from a contactable physician received from the MHRA. Regulatory authority report number GB-MHRA-WEBCOVID-202102170858432420, Safety Report Unique Identifier GB-MHRA-ADR 24778572. An 83-year-old male patient received the first single dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot EJ0553) on 20Dec2020 at single dose, for COVID-19 immunisation. Medical history included osteoarthritis, costochondritis, megaloblastic anaemia NOS, TKR -total prosthetic replacement of knee joint using cement, knee osteoarthritis NOS. The patient had not had symptoms associated with COVID-19, had no COVID-19 test and was not enrolled in clinical trial. Concomitant medications were not reported. Since 24Dec2020 the patient attended A&E four days after having had vaccine with left sided chest pain. He was discharged home with a diagnosis of costochondritis. He collapsed at home the following day in Dec2020 after complaining of back pain, cardiac arrest. The patient died on 25Dec2020. It was unknown if an autopsy was done. Cause of death was reported as death unexplained. Awaiting Post Mortem and Coroners. Chest pain, back pain, cardiac arrest were reported to have a fatal outcome. The outcome of the event costochondritis was unknwon.The reporter was advised to report, due to the frame, but believed the death was unrelated to vaccine. No follow-up activities are possible. No further information is expected. Follow-up (21Feb2021) New information received from a contactable physician via the UK-MHRA includes: Chest pain, back pain, cardiac arrest were reported to have a fatal outcome. No follow-up activities are possible. No further information is expected.; Reported Cause(s) of Death: Chest pain; back pain; cardiac arrest

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