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This is VAERS ID 1304784

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1304784
VAERS Form:2
Age:90.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-06
Onset:2021-05-06
Submitted:0000-00-00
Entered:2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-06
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: Pancreatitis acute
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': JPPFIZER INC2021506944

Write-up: Respiratory arrest / cardiac arrest; Vomiting; This is a spontaneous report from a contactable physician received via Regulatory Authority. A 90-year-old male patient received BNT162B2 (COMIRNATY; Lot number: unknown), dose 1 intramuscular on 06May2021, at 10:30 as single dose for covid-19 immunization. Medical history included pancreatitis acute from an unknown date. The patient''s concomitant medications were not reported. The patient experienced respiratory arrest / cardiac arrest on 06May2021, at 11:45, and vomiting on 06May2021. The reporting physician classified the events as serious as they resulted in death. It was unknown whether the patient received any vaccination within 4 weeks prior to BNT162B2. It was unknown whether the patient received any other medications within 2 weeks of vaccination. Prior to vaccination, it was unknown whether the patient was diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. It was not unknown whether the patient had any allergies to medications, food, or other products. On 06May2021 at 10:30, the patient received the first dose of BNT162b2. On 06May2021 (about 1 hour after the vaccination), the patient experienced vomiting. On 06May2021 at 11:45 (1 hour and 15 minutes after the vaccination), the patient experienced respiratory arrest / cardiac arrest. Therapeutic measures were taken as a result of respiratory arrest / cardiac arrest; the patient received adrenaline administration and resuscitative measure in response to the event. The course of the event was as follows: About 1 hour after vaccination at the short stay (at the nursing home/senior living facility), the patient was transported by emergency to the reporting hospital due to the respiratory arrest/cardiac arrest after vomiting. The event resulted in emergency transport to the reporting hospital. The outcome of the events was fatal. The patient died on 06May2021. An autopsy was not performed and the exact cause of death was unknown. This case was reported because the causality with the vaccine cannot be ruled out completely. The batch/lot number for the vaccine, BNT162B2, was not provided and will be requested during follow-up.; Sender''s Comments: Based on the close temporal relationship, the association between the fatal events cardiorespiratory arrest and vomiting with BNT162b2 can not be completely excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: unknown cause of death

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