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This is VAERS ID 1417454

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First Appeared on 6/25/2021

VAERS ID: 1417454
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted:0000-00-00
Entered:2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Cardiac failure, Dyspnoea, Lethargy, Pain in extremity, Unresponsive to stimuli, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AUPFIZER INC2021710398

Write-up: Cardiac failure; Unresponsive to stimuli; Contusion; Dyspnoea; Lethargy; Pain in extremity; This is a spontaneous report from a contactable other health professional. Regulatory authority report number is 565693. An 84-year-old male patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced Cardiac failure; Contusion; Dyspnoea; Lethargy; Pain in extremity; Unresponsive to stimuli on 17May2021. The events were serious as death. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Cardiac failure; Unresponsive to stimuli; Contusion; Dyspnoea; Lethargy; Pain in extremity

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