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This is VAERS ID 1380067

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1380067
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-04-29
Onset:2021-05-07
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-07
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: 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

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