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This is VAERS ID 1416277

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1416277
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-05-24
Onset:2021-05-25
Submitted:0000-00-00
Entered:2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-25
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: PIRESPA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic respiratory failure; Interstitial pneumonia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': JPPFIZER INC2021703095

Write-up: Death; This is a spontaneous report from a contactable physician received via a Pfizer sales representative. The patient was a 73-year-old male. Medical history included chronic respiratory failure due to interstitial pneumonia. Concomitant medication included pirfenidone (PIRESPA) tablet taken for an unspecified indication, start and stop dates were not reported. On 24May2021 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number and expiration date were not provided) via an unspecified route of administration as 1st dose, single for COVID-19 immunization. On 25May2021 in the morning (1 day after the vaccination), the patient experienced death. The outcome of the event was fatal. It was not reported if an autopsy was performed. The course of the event was as follows: The patient received the first dose of the vaccine and on the following in the morning, the patient was confirmed to be dead. The reporting physician classified the event as serious (death) and assessed that that the event was unrelated to BNT162b2.; Sender''s Comments: Based on the information available the reported event is considered not related to suspect drug.; Reported Cause(s) of Death: Death

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