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This is VAERS ID 1427352

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1427352
VAERS Form:2
Age:74.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-18
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5715 / 1 - / -

Administered by: Other      Purchased by: ??
Symptoms: Body temperature, Death, Hypotonia, Pain, Pyrexia, Mycobacterium tuberculosis complex test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-10
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: Test Date: 20210518; Test Name: Body temperature; Result Unstructured Data: Test Result:mild fever; Test Date: 20210611; Test Name: mycobacterium tuberculosis complex test; Test Result: Positive ; Comments: for TB
CDC 'Split Type': ZAPFIZER INC2021729184

Write-up: Unknown cause of death; Feeling flaccid; Minor body aches; Mild fever; This is a spontaneous report from a contactable pharmacist. A 74-year-old male patient received the first dose of BNT162B2 (PFIZER COVID-19 VACCINE, lot number: FA5715, expiration date: 20May2021), at the age of 74 years old, on 18May2021 13:44 at single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced feeling flaccid, minor body aches and mild fever on 18May2021 20:00. The patient experienced unknown cause of death on 10Jun2021. The patient underwent lab tests and procedures which included body temperature: mild fever on 18May2021 and mycobacterium tuberculosis complex test: positive for TB on 11Jun2021. Therapeutic measures were taken as a result of events feeling flaccid, minor body aches and mild fever. The patient was reported to have passed away in the morning of 10Jun2021. It was not reported if an autopsy was performed. The outcome of the event unknown cause of death was fatal. The outcome of other events was not recovered. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on the plausible temporal relation and limited information, the association between the events of unknown cause of death, flaccidity, aches and fever and the suspect product of BNT162B2 cannot be completely ruled out. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate. ; Reported Cause(s) of Death: Unknown cause of death

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