National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1428277

Government Disclaimer on use of this data



Case Details

VAERS ID: 1428277 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-26
Onset:2021-05-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3558 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DUROGESIC; LEVOTHYROX; AMOXICILLIN; SPIOLTO RESPIMAT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer (Lingual neoplasia); Osteoradionecrosis (of the mandible); Radiotherapy; Surgery (supplemented by radiotherapy given an incomplete resection and lymph node invasion); Surgery (complete resection and multiple reconstructive procedures)
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021682045

Write-up: Death NOS/patient died; This is a spontaneous report from a contactable pharmacist downloaded from the Agency Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-LL20213704, Safety Report Unique Identifier FR-AFSSAPS-2021067152. A 59-year-old male patient received BNT162B2 (COMIRNATY), via intramuscular on 26May2021 13:20 (Lot Number: FC3558) as dose 1, single for COVID-19 immunisation. The patient''s medical history included lingual neoplasia operated on in 2008 supplemented by radiotherapy given an incomplete resection and lymph node invasion. During the course of radiotherapy, the patient presented with osteoradionecrosis of the mandible requiring complete resection with multiple reconstructive procedures. Concomitant medications included fentanyl (DUROGESIC); levothyroxine sodium (LEVOTHYROX); amoxicillin; olodaterol hydrochloride, tiotropium bromide monohydrate (SPIOLTO RESPIMAT); all taken for an unspecified indication, start and stop date were not reported. On 27May2021, the patient died (death NOS) at 8 p.m. (the day after the vaccination). No information on the circumstances. The patient died on 27May2021. It was not reported if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Death of unknown cause is assessed related as a cautionary measure and for reporting purposes. The underlying disease may provide an alternative cause. 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


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1428277


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166