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This is VAERS ID 1375562

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1375562
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-03-29
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-14
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': SKPFIZER INC2021617833

Write-up: Pulmonary embolism; This is a spontaneous report received from a contactable consumer (patient daughter) downloaded from the regulatory authority-WEB (Regulatory Authority number SK-SUKLSK-20214142). A 72-year-old male patient received BNT162B2 (COMIRNATY) intramuscular, on 29Mar2021, at single dose, for COVID-19 immunisation. Medical history was not reported. Concomitant medications included unspecified anticoagulants. On 14Apr2021 the patient experienced pulmonary embolism and died on the same day. The event was reported with a fatal outcome. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Pulmonary embolism

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