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This is VAERS ID 1304884

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1304884
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-04-26
Onset:2021-04-29
Submitted:0000-00-00
Entered:2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLPFIZER INC2021496800

Write-up: Sudden death; This is a spontaneous report received from a contactable physician downloaded from the Agency Regulatory Authority-WEB. The regulatory authority report number is NL-LRB-00524561. A 69-year-old male patient received the BNT162B2 (COMIRNATY, batch/lot number and expiration date not provided), via an unspecified route of administration, on 26Apr2021, at 0.3 mL single dose, for COVID-19 immunization. Medical history and concomitant medications were not reported. No previous COVID-19 infection. The patient experienced sudden death on 29Apr2021, no symptoms prior to death. The outcome of the event was fatal. The cause of death was not reported. Autopsy was performed and no results available. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: sudden death

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