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This is VAERS ID 1113862

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1113862
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-19
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP9598 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Sudden cardiac death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LANSOPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Pneumonia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NOPFIZER INC2021250343

Write-up: Sudden cardiac death; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority. Regulatory authority report number is NO-NOMAADVRE-FHI-2021-Uw1p5, Safety Report Unique Identifier NO-NOMAADVRE-E2B_00017156. An 84-year-old male patient received first dose of bnt162b2 (COMIRNATY, lot number: EP9598, expiry date not reported), intramuscular at the left arm on 19Feb2021 11:00 at single dose for COVID-19 immunization. Medical history included pneumonia from 2018 to 2018. Concomitant medication included lansoprazole for Gastrooesophageal reflux disease. The patient experienced sudden cardiac death on 24Feb2021. An autopsy was not performed. Case narrative as reported: An 84 years old man with gastro-esophageal reflux disease in periods was otherwise healthy, working and leading an active lifestyle. He has not seen his physician in the last 6 years except for pneumonia in 2018. The patient died suddenly and unexpectedly 5 days after first dose of COVID-19 vaccination (Comirnaty). There were no other known symptoms after vaccination, or known other causes, and the man died while jogging. Anesthesiologist tried heart and lung resuscitation (HLR) and later found no burst blood vessels. Cause of death was stated as sudden cardiac death. No autopsy is planned. Sender Comment: On the basis of the information in the report and in accordance with international criteria, the causal relationship with vaccination is assessed as possible. A possible causal relationship is defined as a reaction, including pathological laboratory tests, which occurs in a temporal relation to the use of a drug, but which may also be due to an underlying disease, other drugs or chemicals. Since the patient died, the report is also classified as serious, even though a causal link between the vaccine and the death has not been established. Event assessment Sudden cardiac death for Comirnaty Source of assessment Facility Result of Assessment Possible Reporter''s comments : 03Mar2021 : additional information received. The following fields have been updated: Event, Event description. An 84 years old man with gastro-esophageal reflux disease in periods was otherwise healthy, working and leading an active lifestyle. He has not seen his physician in the last 6 years except for pneumonia in 2018. The patient died suddenly and unexpectedly 5 days after first dose of COVID-19 vaccination (Comirnaty). There were no other known symptoms after vaccination, or known other causes, and the man died while jogging. Anesthesiologist tried heart and lung resuscitation (HLR) and later found no burst blood vessels. Cause of death was stated as sudden cardiac death. No autopsy is planned. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: 03Mar2021 : additional information received. The following fields have been updated: Event, Event description. An 84 years old man with gastro-esophageal reflux disease in periods was otherwise healthy, working and leading an active lifestyle. He has not seen his physician in the last 6 years except for pneumonia in 2018. The patient died suddenly and unexpectedly 5 days after first dose of COVID-19 vaccination (Comirnaty).; Reported Cause(s) of Death: sudden cardiac death

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