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This is VAERS ID 1380214

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1380214
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-05-28
Onset:2021-05-28
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA8016 / 1 LA / OT

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Cardiac arrest, Loss of consciousness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-28
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: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITPFIZER INC2021645696

Write-up: Abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers; Abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers; Abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB, regulatory authority number IT-MINISAL02-737092. A 52-year-old male patient received first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot Number: FA8016), via intramuscular, administered in arm left (left shoulder) on 28May2021 at 13:00 as 1st dose, single dose for COVID-19 immunisation. Medical history included hypertension. The patient''s concomitant medications were not reported. On 28May2021, the patient experienced abdominalgia and vagal symptoms and sudden loss of consciousness, cardiocirculatory arrest not recovered by rescuers. The patient died on 28May2021. It was not reported if an autopsy was performed. Outcome of the events fatal. Sender Comment: 30May2021 added clinical report Reporter''s comment: The relationship is temporal: the causal link has to be demonstrated. Body under judicial protection following a complaint by family members.; Reporter''s Comments: The relationship is temporal: the causal link has to be demonstrated. Body under judicial protection following a complaint by family members; Reported Cause(s) of Death: Consciousness loss; Abdominal pain; Arrest cardiac

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