National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/12/2021 release of VAERS data:

This is VAERS ID 1380067

Government Disclaimer on use of this data



Case Details

VAERS ID: 1380067 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-29
Onset:2021-05-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX3599 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SIOFOR; TENOX [AMLODIPINE MALEATE]; TRITAZIDE; TRICOR [FENOFIBRATE]; COUPET; CONCOR COR
Current Illness: Diabetes mellitus; Hyperlipidemia; Hypertonia (hypertonia arterialis)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: HRPFIZER INC2021630142

Write-up: death / died suddenly; This is a spontaneous report from a contactable physician via Regulatory Authority, downloaded from the ERegulatory Authority-WEB (HR-HALMED-300047965). A 67-year-old male patient received bnt162b2 (COMIRNATY) intramuscular on 29Apr2021 (Batch/Lot Number: EX3599) at 0.3 mL single (unknown if first or second dose) for COVID-19 immunisation. Relevant medical history included ongoing hyperlipidaemia, ongoing diabetes mellitus and ongoing hypertonia arterialis. Concomitant medications included metformin hydrochloride (SIOFOR); amlodipine maleate (TENOX); hydrochlorothiazide/ramipril (TRITAZIDE); fenofibrate (TRICOR); rosuvastatin calcium (COUPET); bisoprolol fumarate (CONCOR COR); all taken for unspecified indications, start and stop dates were not reported. On 07May2021, the patient died suddenly. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information expected.; Reported Cause(s) of Death: death / died suddenly


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1380067


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166