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This is VAERS ID 1428138

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1428138
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-06-17
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-06-25
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: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': DEPFIZER INC2021750946

Write-up: Death; This is a spontaneous report from a contactable physician based on information received by Pfizer from Biontech [manufacturer control number: 66739], license party for Comirnaty. An unspecified age male patient received the first dose of BNT162B2 (COMIRNATY) via an unspecified route of administration on 17Jun2021 as single dose for COVID-19 immunization. Medical history and concomitant medication were not reported. The patient experienced death on an unknown date. Reported as: The patient dead after the first vaccination with COMIRNATY. The outcome of event was fatal. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the limited information in the case report a meaningful assessment of a causal relationship is not possible. The case will be reassessed once additional information will be available. 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: Death

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