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This is VAERS ID 1380063

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1380063
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-02-26
Onset:2021-03-01
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP9598 / 1 - / OT

Administered by: Other      Purchased by: ??
Symptoms: Computerised tomogram, Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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: CORDARONE; TULIP [SIMVASTATIN]; FURSEMID [FUROSEMIDE]; COUPET; LANTUS; OLICARD; ACIPAN; CO DALNEVA; KALINOR [CITRIC ACID;POTASSIUM BICARBONATE;POTASSIUM CITRATE]; CONCOR COR; GLUCOPHAGE [METFORMIN HYDROCHLORIDE]; PREDUCTAL; MARTEFARIN
Current Illness: Arterial hypertension; Atherosclerosis; Atrial fibrillation; Diabetes mellitus; Diverticula of colon; Gastritis chronic; Gastroduodenitis; Hypertensive cardiomyopathy; Lipid metabolism disorder NOS; Mitral valve disease
Preexisting Conditions: Medical History/Concurrent Conditions: Edema pulmonary; Post MI; Respiratory insufficiency
Allergies:
Diagnostic Lab Data: Test Date: 20210301; Test Name: CT of the abdomen; Result Unstructured Data: Test Result:unknown results
CDC 'Split Type': HRPFIZER INC2021589070

Write-up: Death sudden/Collapsed and died after examination; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB [Regulatory authority number HR-HALMED-300047566]. An 83-year-old male patient received bnt162b2 (COMIRNATY), intramuscular on 26Feb2021 (Batch/Lot Number: EP9598) as 1st dose, 0.3 mL, single for COVID-19 immunization. Ongoing medical history included hypertensive cardiomyopathy, mitral valve disease, diverticula of colon, atherosclerosis, gastroduodenitis, chronic gastritis, diabetes mellitus, dysfunctions of lipoprotein metabolism, arterial hypertension and atrial fibrillation. The patient also had pulmonary oedema, post myocardial infarction (MI) and respiratory insufficiency from Nov2020 to an unknown date. Concomitant medications included pantoprazole sodium sesquihydrate (ACIPAN) taken for chronic gastritis from unknown therapy dates; and amiodarone hydrochloride (CORDARONE), simvastatin (TULIP), furosemide (FURSEMID), rosuvastatin calcium (COUPET), insulin glargine (LANTUS), isosorbide mononitrate (OLICARD), amlodipine besilate, indapamide, perindopril erbumine (CO DALNEVA), citric acid, potassium bicarbonate, potassium citrate (KALINOR), bisoprolol fumarate (CONCOR COR), metformin hydrochloride (GLUCOPHAGE), trimetazidine hydrochloride (PREDUCTAL) and warfarin sodium (MARTEFARIN) all taken unspecified indications and therapy dates. It was reported that the patient was called for a second dose of the vaccine and it was learned from their son that the patient had died. It was narrated that the patient went for an earlier scheduled CT of the abdomen (unknown results) on 01Mar2021 and after the examination he collapsed and died (death sudden). It was not reported if an autopsy was performed. Health Authority Comment: 13May2021: The reporter was requested to provide follow-up information on the case including autopsy report, death cause, relevant hospitalization data. 14May2021: Follow-up information was received containing only data on previous hospitalization / diagnostic procedures, medical conditions / history and medication list (data from 2020). The reporter did not receive any information from the patient''s family on the cause of death or information if the autopsy has been made. Comirnaty: Regulatory Authority/ Health Authority / Unassessable/Unclassifiable. Causality assessment from the Regulatory Authority meeting is still awaited. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Collapsed and died after examination

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