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This is VAERS ID 1377256

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1377256
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-04-20
Onset:2021-04-23
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Cardiac failure acute, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-01
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': DEPFIZER INC2021616454

Write-up: Unknown cause of death; Acute cardiac insufficiency; This is as spontaneous report from a non-contactable physician downloaded from the regulatory authority-WEB. The regulatory authority report number is DE-PEI-202100077664. An elderly male patient of an unknown age received bnt162b2 (COMIRNATY), via an unspecified route of administration on 20Apr2021 (Lot Number: Unknown) as 0.3 mL single dose for covid-19 immunisation. Medical history and concomitant medications were not reported. On 23Apr2021 patient experienced acute cardiac insufficiency and on 01May2021 patient experienced unknown cause of death. Both events were considered serious due to fatal outcome. An autopsy was not performed. Relatedness of drug to reactions/events (All events) was reported as D. Unclassifiable. Source of assessment: PEI No follow-up attempts possible. No further information expected. Information on lot and batch numbers cannot be obtained.; Reported Cause(s) of Death: Acute cardiac insufficiency; Unknown cause of death

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